Asymmetric Periflexural Exanthem of Childhood Clinical Presentation

Updated: May 14, 2018
  • Author: Patricia T Ting, MD, MSc, FRCPC, LMCC(Canada); Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Most affected children are healthy and asymptomatic at presentation, with an unremarkable medical history. Occasionally, patients may report a current and/or recent episode of upper respiratory tract infection, adenopathy/lymphadenopathy, fever, otitis media, or diarrhea. In rare instances, other children in the family may also have asymmetric periflexural exanthem of childhood. Mild pruritus is reported in approximately 50% of patients.

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Physical Examination

The primary (pathognomonic) lesion is a small erythematous papule with a surrounding pale halo. The general appearance of lesions includes a morbilliform, eczematous, and occasionally reticulated group of macules, papules, or coalescent plaques. These are occasionally accompanied with fine scaling.

At the initial onset, lesions are unilateral and usually begin near the axillae, lateral trunk, and upper inner arm or groin. During the course of the condition, lesions often progress bilaterally with an asymmetric predominance.

The 4 sequential stages of the lesions are as follows:

  1. Eczematous, when initial lesions occur on the axillae and lateral chest wall

  2. Coalescence, when lesions extend to the trunk and proximal extremities and are separated by areas of normal skin

  3. Regression, when older lesions may develop a central dusky-gray center

  4. Desquamation, when residual branlike scale appears and resolves with time

Asymmetric periflexural exanthem of childhood lesions spare the face, palms, soles, and mucous membranes. Lichenification is not usually observed. See the images below.

Morbilliformlike eruption in a child with involvem Morbilliformlike eruption in a child with involvement of the axilla, lateral thorax, and abdomen. Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.
Eczematouslike eruption with a predominantly hemic Eczematouslike eruption with a predominantly hemicorporeal distribution photographed on the eighth day after initial appearance of lesions. Used with permission from Bodemer and de Prost (1992) from the Journal of the American Academy of Dermatology.
Pattern of reticulated plaques on the posterior lo Pattern of reticulated plaques on the posterior lower limb of a child. Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.
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