Pediatric Acropustulosis

Updated: Apr 15, 2019
  • Author: Vernon J Forrester, MD; Chief Editor: Dirk M Elston, MD  more...
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Overview

Background

Infantile acropustulosis is a recurrent, self-limited, intensely pruritic, vesiculopustular eruption of the palms and soles, occurring in infants aged 2-12 months. This uncommon disorder was first described in 1979.

See the image below.

Lateral and plantar foot exhibiting acropustulosis Lateral and plantar foot exhibiting acropustulosis. A combination of intact acute vesicles and brownish hyperpigmentation of old vesicles is present.
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Pathophysiology

The etiology of infantile acropustulosis is unknown. Many incidents of acropustulosis are preceded by documented or suspected scabies infestation, which may suggest a scabies id reaction. [1] However, incidents of newborns affected with acropustulosis have been reported, making a scabies reaction an unlikely source for the eruption in every case; scabies infestation has been thoroughly excluded in some well-documented cases of acropustulosis. Bacterial and viral cultures are consistently negative, and negative immunofluorescence on biopsy suggests that infantile acropustulosis is not an autoimmune process. [2] An association has been identified between acropustulosis of infancy and atopy. [3]

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Etiology

The cause of acropustulosis is unknown.

Scabies (Sarcoptes scabiei infection)as a preceding or concomitant infestation in the same patient is well documented. However, cases have been described in which a history of scabies was excluded. Many children are undoubtedly misdiagnosed as having scabies and are treated with lindane or permethrin prior to presentation.

Some studies suggest that acropustulosis and neonatal eosinophilic pustular folliculitis are associated and may be manifestations of the same underlying disease. [4, 5]

No other infectious agent has been documented.

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Epidemiology

Frequency

United States

The incidence is unknown. Typically, acropustulosis affects children younger than 3 years.

International

The incidence is unknown. One report from Israel diagnosed 25 individuals with acropustulosis in a 9-year period, suggesting this condition is not as uncommon as once believed. [6] Another report noted that acropustulosis was not uncommon among internationally adopted children, especially with prior exposure to overcrowded living conditions and potential scabies infestations. [7]

Race

Early reports suggested a predominance of incidence in black individuals; however, all races are now believed to be equally affected. [6]

Sex

Early reports suggested a male predominance. Larger series have since demonstrated an equal distribution between males and females. [6]

Age

Although acropustulosis has been reported in children as old as 9 years, it typically begins within the first 2-12 months of life. Resolution by the time the individual is aged 3 years is usual.

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Prognosis

Prognosis is excellent. Generally, bouts of pruritic vesicopustules decrease in severity with successive outbreaks and most disappear altogether by the time the individual is aged 2-3 years, with definite resolution by age 9 years.

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