Papulovesicular acro-located syndrome

Alternative names
Papular acrodermatitis of childhood; Gianotti-Crosti syndrome; Acrodermatitis - infantile lichenoid; Acrodermatitis - papular infantile; Acrodermatitis

Definition
Acrodermatitis is a skin condition peculiar to children that may be accompanied by mild symptoms of fever and malaise. It may also be associated with Hepatitis B and other viral infections.

Causes, incidence, and risk factors

The mechanism that causes acrodermatitis is poorly understood, but its association with other infections is well documented. The lesions of acrodermatitis appear as small coppery-red, flat-topped firm papules that appear in crops and sometimes in long linear strings.

The lesions are often symmetric (equal on both sides) and appear on the face, arms and legs, and buttocks. This is one of the few rashes that may also appear on the palms and soles. Generalized enlargement of the lymph nodes and liver may be seen.

In Italian children, acrodermatitis is seen frequently in conjunction with Hepatitis B, but this association is rarely seen in the USA. In addition to Hepatitis B, acrodermatitis has also been associated with Epstein-Barr virus infections (EBV, mononucleosis), cytomegalovirus, coxsackie viruses, parainfluenza virus, respiratory syncytial virus (RSV), and some live virus vaccines.

Symptoms

     
  • Skin lesion or rash  
  • Brownish-red or copper-colored papule that is flat-topped and firm  
  • Rash that may appear as a linear string of >papules  
  • Generally not itchy  
  • Symmetrical distribution (looks the same on both sides of the body)  
  • Rash may appear on the palms and soles

Other symptoms that may appear include:

     
  • Enlarged abdomen (because the liver and spleen can become enlarged)  
  • Enlarged lymph nodes  
  • Tender lymph nodes

Signs and tests

Physical examination confirms the appearance of the rash. The liver and spleen may be enlarged (hepatosplenomegaly). The lymph nodes may be enlarged or tender (lymphadenopathy).

Tests that may be performed to confirm the diagnosis and to diagnose associated diseases include:

     
  • Skin biopsy  
  • Liver enzymes (liver function tests)  
  • Hepatitis virus serology or Hepatitis B surface antigen  
  • Screening for EBV antibodies  
  • Bilirubin level

Treatment

Acrodermatitis by itself is not treated. Associated conditions, such as Hepatitis B and Epstein-Barr virus infection, should be managed appropriately.

Expectations (prognosis)

Acrodermatitis is considered a self-limiting disease that disappears without complication. However, the associated conditions must be watched carefully.

Complications

Complications occur as a result of associated conditions, rather than as a result of acrodermatitis.

Calling your health care provider

Call your health care provider if signs or symptoms (as described here) are present.

Johns Hopkins patient information

Last revised: December 4, 2012
by Amalia K. Gagarina, M.S., R.D.

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