You are in: eMedicine Specialties > Dermatology > PEDIATRIC DISEASES Asymmetric Periflexural Exanthem of ChildhoodArticle Last Updated: Feb 16, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Stewart P Adams, MD, FRCPC, Clinical Assistant Professor, Department of Medicine, University of Calgary Faculty of Medicine Stewart P Adams is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Canadian Medical Association Coauthor(s): Patricia T Ting, MD, Staff Physician, Department of Medicine, University of Calgary Editors: Timothy McCalmont, MD, Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic; Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; 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: unilateral laterothoracic exanthem of childhood, ULE, APEC, papular erythema INTRODUCTIONSection 2 of 10
  BackgroundIn 1962, Brunner et al reported a "new papular erythema" in 75 children aged 6 months to 5 years. Later, in 1992, Bodemer and de Prost published a case series of 18 children and named the condition unilateral laterothoracic exanthem (ULE). In 1993, Taieb and colleagues suggested the term asymmetric periflexural exanthem of childhood (APEC) to replace ULE, as the latter did not fully depict the morphologic distribution of the skin lesions present in this condition. APEC is classified as a rare self-limited and spontaneously resolving exanthem with unknown etiology that occurs in children. To date, only 3 case presentations in adults have been documented. PathophysiologyThe etiology of APEC is unknown. The patient's history (eg, age at presentation, multiple affected children in a family), lack of efficacy of broad-spectrum antibiotic treatment, serologic findings, and the tendency for presentation during spring and winter raise the possibility of a viral etiology. However, the evidence has been inconclusive, and clinicians have not been able to isolate a specific virus. Therefore, this hypothesis has never been confirmed. APEC manifests as an exanthem with stereotypical morphology and distribution. Biopsy is rarely if ever performed, as the presentation of this condition is unique and resolves spontaneously without treatment or adverse sequelae. FrequencyUnited StatesAPEC is a relatively rare condition that often appears in spring and winter months. InternationalApproximately 300 cases have been reported in the literature. Case series of affected children have been documented internationally from the United States, Canada, and Europe. Mortality/MorbidityNone is reported. RaceAPEC predominantly affects individuals from light-skinned ethnic groups. SexAPEC tends to affect females more frequently than males, with an estimated female-to-male ratio of 2:1. Age
CLINICALSection 3 of 10
History
Physical
CausesThe exact cause of this eruption is unknown, and no specific viral pathogens have been identified. DIFFERENTIALSSection 4 of 10
Contact Dermatitis, Allergic Drug Eruptions Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood) Milia Miliaria Pityriasis Rosea Scabies Scarlet Fever Tinea Corporis
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| Drug Name | Hydroxyzine hydrochloride (Vistaril, Atarax, Vistazine) |
|---|---|
| Description | Antagonizes H1 receptors in periphery. May also suppress histamine activity in subcortical region of CNS. |
| Adult Dose | 50-100 mg PO qd/qid |
| Pediatric Dose | <6 years: 50 mg/d PO (2 mg/kg/d) in divided doses >6 years: 50-100 mg/d PO in divided doses All age groups: 1 h qhs |
| Contraindications | Documented hypersensitivity |
| Interactions | Potentiates effect of CNS depressants and alcohol. Syrup formulation contains alcohol; do not give to patients taking medications with disulfiramlike properties. |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Causes drowsiness; caution when operating heavy machinery or motor vehicles; may exacerbate porphyria, angle-closure glaucoma, hyperthyroidism, peptic ulcer, and anticholinergic effects (eg, dry mouth, urinary tract obstruction); ECG abnormalities (T-wave alterations) reported |
These agents provide relief of inflammatory eczematous lesions.
| Drug Name | Hydrocortisone - topical (LactiCare-HC, Cortaid, Cortate) |
|---|---|
| Description | Low-potency topical corticosteroid with anti-inflammatory activity, as well as mineralocorticoid and glucocorticoid properties. Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Use 1% cream. |
| Adult Dose | Apply sparingly to affected areas bid/tid as needed |
| Pediatric Dose | Apply as in adults |
| Contraindications | Documented hypersensitivity; do not use for bacterial, fungal, or viral infections |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Avoid contact with eyes (risk of cataracts); prolonged or excessive use over large surface areas and with occlusive dressings may increase systemic absorption, leading to Cushing syndrome, reversible HPA-axis suppression, hyperglycemia, and glycosuria |
| Media file 1: 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. | |
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| Media file 2: 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. | |
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| Media file 3: 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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| Media file 4: Histopathologic slide demonstrates perivascular, interstitial, and periadnexal infiltrate of lymphocytes and histiocytes in the deep dermis (hematoxylin-phloxine-saffron stain). Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology. | |
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| Media file 5: Histopathologic slide demonstrates epidermal spongiosis and lymphocytic infiltration of the intraepidermal portion of an eccrine duct (hematoxylin-phloxine-saffron stain). Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology. | |
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Asymmetric Periflexural Exanthem of Childhood excerpt
Article Last Updated: Feb 16, 2007
