Approach Considerations

Diagnostic criteria for Gianotti-Crosti syndrome have been proposed and include the following^{[39, 40]}:

The presence of all of the following positive clinical features:
- Monomorphous, flat-topped, pink-brown papules or papulovesicles 1-10 mm in diameter
- At least three of the following four sites involved: cheeks, buttocks, extensor surfaces of forearms, extensor surfaces of legs
- Symmetric eruption
- Duration of at least 10 days
The absence of extensive truncal lesions and scaling
Exclusion of alternative diagnoses as more compatible as based on clinical judgment
Compatible histopathologic findings, if skin biopsy is performed

Laboratory Studies

Laboratory studies are not generally indicated. Blood counts may reveal a lymphocytosis and a relative monocytosis or a lymphopenia secondary to an underlying viral infection, if present.

In cases associated with acute infection with the hepatitis B virus, EBV, or CMV, anicteric hepatitis is evident by elevations in the levels of hepatic transaminases and antiviral antibodies. A viral agent can be identified in approximately one third of cases. If a specific infectious etiology is suspected, testing can be directed at potential etiologies, as follows:

EBV - Monospot, immunoglobulin M (IgM) and immunoglobulin G (IgG) titers, or serum polymerase chain reaction (PCR)
CMV - IgM and IgG titers, serum CMV antigen levels, or serum PCR
RSV, parainfluenza virus, other respiratory viral pathogens - Nasal washing for fluorescent antibody testing or PCR
Enterovirus - Culture or PCR from serum
Parvovirus B19 - IgM and IgG titers or serum PCR
HHV-6 - Serum PCR
Group A beta-hemolytic streptococci - Serum PCR or pharyngeal culture

Histologic Findings

The histology of skin biopsy specimens is nonspecific. Mild epidermal acanthosis and spongiosis with focal parakeratosis can be seen. A lymphocytic exocytosis may also be seen. Edema of the papillary dermis and a superficial lymphohistiocytic infiltrate, sometimes with a perivascular localization or a lichenoid appearance, is common. Rarely, features of a lymphocytic vasculitis have been noted.

Treatment & Management

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Media Gallery

Characteristic erythematous papules of Gianotti-Crosti syndrome appear on the face of this child. The child does not have a toxic appearance.
Characteristic erythematous papules of Gianotti-Crosti syndrome can be seen on the extremities, as is the case in this young child.
A 9-year-old girl who recently returned from a trip to Europe with her family. She developed a low-grade fever, malaise, and some lymphadenopathy. An eruption limited to her face, arms, legs, and buttocks was noted.
A mildly pruritic eruption characterized by erythematous papules localized to the face, arms, legs, and buttocks.