AUTHOR AND EDITOR INFORMATION

Section 1 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

INTRODUCTION

Section 2 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Background

Infantile acropustulosis is a recurrent, self-limited, pruritic, vesiculopustular eruption of the palms and soles, occurring in infants aged 2-3 years. First described in 1979, the disorder is probably much more common than implied by the scarcity of reports.

Pathophysiology

The pathophysiology is unknown. Many incidents of acropustulosis are preceded by documented or suspected scabies infestation, and a scabies id reaction has been suggested. However, incidents of newborns affected with acropustulosis have been reported, making scabies reaction an unlikely source for the eruptions; scabies infestation has been thoroughly excluded in 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.

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 that this condition is not as uncommon as once believed.¹

Mortality/Morbidity

All incidents of acropustulosis spontaneously resolve in a few months to 3 years.

Race

Early reports suggested a predominance of incidence in African-American individuals; however, all races now are believed to be equally affected.

Sex

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

Age

Although acropustulosis has been reported in children as old as age 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.

CLINICAL

Section 3 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

History

• Typically, an infant aged 2-12 months exhibits pruritic erythematous macules or papules that progress into vesicles and then pustules.
• Children with acropustulosis are fretful, irritable, and obviously uncomfortable but otherwise well.
• Individual bouts of the condition last 7-15 days and recur at 2- to 4-week intervals. Intensity and duration diminish with each recurrence.
• Most children have been treated with antiscabies medications prior to presentation.

Physical

• The hands and feet always are involved, usually on the palms, soles, and lateral surfaces. Lesions may occur on the dorsal hands and feet, trunk, scalp, and face.
• Lesions begin as small macules or papules that eventually form distinct, noncoalescing vesicles and pustules. They resolve with macular hyperpigmentation (see Image 1).
• No other organ systems are involved.

Causes

• The cause of acropustulosis is unknown.
• Scabies as a preceding or concomitant infestation is well documented.
• • However, cases have been described in which a present or past history of scabies was excluded.
  • Many children are undoubtedly misdiagnosed as having scabies and are treated with lindane or permethrin prior to presentation.
• No other infectious agent has been documented.

DIFFERENTIALS

Section 4 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Other Problems to be Considered

Eosinophilic pustulosis
Hand-foot-and-mouth disease (most commonly Coxsackie virus type A-16)
Pustular psoriasis
Transient neonatal pustular melanosis

WORKUP

Section 5 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Lab Studies

• Acropustulosis is a clinical diagnosis. Laboratory studies are used only to exclude potentially treatable infectious etiologies.
• A CBC count often demonstrates eosinophilia.
• Cultures and smears help exclude an infectious cause.

Histologic Findings

A unilocular, subcorneal, or intraepidermal pustule containing neutrophils or eosinophils is characteristic. Papillary dermal edema and a mild, perivascular, mostly lymphocytic infiltrate in the dermis may be present. Results of direct immunofluorescence are negative.

TREATMENT

Section 6 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Medical Care

• Treatment is not necessary because of the self-limited nature of this condition; however, topical steroids and oral dapsone have been used with good success.

Consultations

• Pediatric dermatologist
• Dermatologist

Diet

No dietary changes are necessary.

Activity

No activity changes are necessary.

MEDICATION

Section 7 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

High-potency topical steroids (class 1 and 2) have been successfully used for control of pruritus. Extremely symptomatic children may be treated with dapsone at a dose of 1-2 mg/kg/d.

Drug Category: Glucocorticoids, topical

These agents elicit anti-inflammatory properties. They modify the body's immune response to diverse stimuli. These drugs provide symptomatic relief of pruritus.

Drug Category: Antibiotics

Dapsone is a diaminodiphenylsulfone antibiotic that may be used as anti-inflammatory agent.

FOLLOW-UP

Section 8 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

In/Out Patient Meds

• High-potency topical steroids have been used for control of pruritus.
• Extremely symptomatic children may be treated with dapsone.

Complications

• Secondary bacterial infection may occur if lesions are excoriated.

Prognosis

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

MULTIMEDIA

Section 9 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

Media file 1:  Lateral and plantar foot exhibiting acropustulosis. A combination of intact acute vesicles and brownish hyperpigmentation of old vesicles is present.
	View Full Size Image
Media type:  Photo

REFERENCES

Section 10 of 10

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Multimedia
• References

1. Dromy R, Raz A, Metzker A. Infantile acropustulosis. Pediatr Dermatol. Dec 1991;8(4):284-7. [Medline].
2. Braun-Falco M, Stachowitz S, Schnopp C, et al. Infantile acropustulosis successfully controlled with topical corticosteroids under damp tubular retention bandages. Acta Derm Venereol. May 2001;81(2):140-1. [Medline].
3. Humeau S, Bureau B, Litoux P, Stalder JF. Infantile acropustulosis in six immigrant children. Pediatr Dermatol. Sep 1995;12(3):211-4. [Medline].
4. Kahn G, Rywlin AM. Acropustulosis of infancy. Arch Dermatol. Jul 1979;115(7):831-3. [Medline].
5. Mancini AJ, Frieden IJ, Paller AS. Infantile acropustulosis revisited: history of scabies and response to topical corticosteroids. Pediatr Dermatol. Sep-Oct 1998;15(5):337-41. [Medline].
6. Prendiville JS. Infantile acropustulosis--how often is it a sequela of scabies?. Pediatr Dermatol. Sep 1995;12(3):275-6. [Medline].
7. Vicente J, Espana A, Idoate M, et al. Are eosinophilic pustular folliculitis of infancy and infantile acropustulosis the same entity?. Br J Dermatol. Nov 1996;135(5):807-9. [Medline].

Article Last Updated: Aug 6, 2007