You are in: eMedicine Specialties > Dermatology > PEDIATRIC DISEASES Acropustulosis of InfancyArticle Last Updated: Mar 28, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 11
  Author: Howard Pride, MD, Associate Professor, Departments of Pediatrics and Dermatology, Geisinger Medical Center Howard Pride is a member of the following medical societies: American Academy of Dermatology and Society for Pediatric Dermatology Editors: Daniel Mark Siegel, MD, MS, Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate; Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center; Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center Author and Editor Disclosure Synonyms and related keywords: infantile acropustulosis, infant acropustulosis INTRODUCTIONSection 2 of 11
  BackgroundInfantile acropustulosis is a recurrent, self-limited, pruritic, vesicopustular eruption of the palms and the soles occurring in young children during the first 2-3 years of life. Newly described in 1979, it is probably much more common than the scarcity of reports would imply. PathophysiologyThe pathophysiology of infantile acropustulosis is unknown. Many cases are preceded by well-documented or suspected scabies infestation, and a scabies id reaction has been suggested. More often, cases occur despite scabies having been thoroughly ruled out. Bacterial and viral culture results are consistently negative, and negative immunofluorescence results suggest that infantile acropustulosis is not an antibody-mediated autoimmune process. FrequencyUnited StatesThe exact incidence is unknown. InternationalThe exact incidence is unknown. One study from Israel reported 25 cases in a 9-year period, suggesting that this is not as uncommon as once thought. Mortality/MorbidityAll cases spontaneously resolve in a few months to 3 years. RaceEarly reports suggested a predominance of African Americans. Now, acropustulosis is believed to affect all races equally. SexEarly reports suggested a male predominance. Larger series have since shown an equal distribution between males and females. AgeAlthough children as old as 9 years have been reported, acropustulosis typically begins between the first 2-12 months of life. Resolution by age 3 years is the norm. CLINICALSection 3 of 11
History
Physical
CausesThe cause of infantile acropustulosis is unknown. Scabies as a preceding or concomitant infestation is well documented in some cases. Many children are undoubtedly misdiagnosed as having scabies and treated with lindane or permethrin without any confirmatory scrapings. No other infectious agent has been documented. DIFFERENTIALSSection 4 of 11
Candidiasis, Cutaneous Chickenpox Cutaneous Larva Migrans Dyshidrotic Eczema Erythema Toxicum Neonatorum Fire Ant Bites Hand-Foot-and-Mouth Disease Impetigo Psoriasis, Pustular Scabies Transient Neonatal Pustular Melanosis Vesicular Palmoplantar Eczema
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| Drug Name | Betamethasone (Diprolene, Betatrex) |
|---|---|
| Description | For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Use fluorinated topical steroids with caution in children. |
| Pediatric Dose | Apply thin film to affected areas bid; occlusion increases effectiveness; avoid wraps that may present choking hazard |
| Contraindications | Documented hypersensitivity; paronychia; cellulitis; impetigo; angular cheilitis; erythrasma; erysipelas; rosacea; perioral dermatitis; acne |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Application over large surface areas may cause systemic absorption and adrenal suppression; do not use on skin with decreased circulation; can cause atrophy of groin, face, and axillae; if infection develops and is not responsive to antibiotic treatment, discontinue until infection is under control |
Diaminodiphenylsulfone antibiotics have been used as anti-inflammatory agents.
| Drug Name | Dapsone (Avlosulfon) |
|---|---|
| Description | Bactericidal and bacteriostatic against mycobacteria; mechanism of action is similar to that of sulfonamides where competitive antagonists of PABA prevent formation of folic acid, inhibiting bacterial growth. Used mainly to treat leprosy and dermatitis herpetiformis. Has antineutrophil and anti-inflammatory properties. |
| Pediatric Dose | 1-2 mg/kg/d PO; not to exceed 100 mg |
| Contraindications | Documented hypersensitivity; known G-6-PD deficiency (assay for G-6-PD activity prior to initiation of therapy) |
| Interactions | May inhibit anti-inflammatory effects of clofazimine; hematologic reactions may increase with folic acid antagonists, eg, pyrimethamine (monitor for agranulocytosis during second and third months of therapy); probenecid increases toxicity; trimethoprim with dapsone may increase toxicity of both drugs; because of increased renal clearance, levels may significantly decrease when administered concurrently with rifampin |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Associated with a variety of systemic toxicities, including agranulocytosis, anemia, methemoglobinemia, hepatitis, and neuropathy; patients may experience headache and/or GI distress on initiation of therapy; perform weekly blood counts (first mo), then monthly WBC counts (6 mo), then semiannual WBC counts; discontinue if a significant reduction in platelets, leukocytes, or hematopoiesis occurs; caution in methemoglobin reductase deficiency, G-6-PD deficiency, or hemoglobin M because of high risk for hemolysis and Heinz body formation Caution in patients exposed to other agents or conditions (eg, infection, diabetic ketosis) capable of producing hemolysis; peripheral neuropathy can occur (rare); phototoxicity may occur when exposed to UV light; pancreatitis may occur; various forms of renal complications including acute renal failure, acute tubular necrosis, and oliguria have occurred with dapsone use |
These agents may relieve associated itching.
| Drug Name | Pramoxine (Tronothane, Prax) |
|---|---|
| Description | Blocks nerve conduction and impulses by inhibiting depolarization of neurons. Use 1% lotion or cream. |
| Pediatric Dose | Apply to affected area prn; not to exceed 200 mg |
| Contraindications | Documented hypersensitivity; do not apply over large areas; avoid contact with eyes and nose |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Caution in patients with trauma in area to be treated |
| Media file 1: Lateral and plantar aspects of the foot with a combination of intact acute vesicles and brownish hyperpigmentation of old vesicles. | |
 | View Full Size Image | Media type: Photo |
Acropustulosis of Infancy excerpt
Article Last Updated: Mar 28, 2007
