Pediatric Acropustulosis

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Pediatric Acropustulosis

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Infantile acropustulosis is a recurrent, self-limited, intensely pruritic, vesiculopustular eruption of the palms and soles, occurring in infants aged 2-3 years. This disorder was first described in 1979 and was noted to be uncommon, yet not rare. Pediatric acropustulosis is probably much more common than implied by the scarcity of reports.

See the image below.

The pathophysiology is suspected scabies infestation. Many incidents of acropustulosis are preceded by documented or suspected infestation, which may suggest a scabies id reaction. 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. [1]

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. [2] Another report noted that acropustulosis was not uncommon among internationally adopted children, especially with prior exposure to overcrowded living conditions and potential scabies infestations. [3]

Early reports suggested a predominance of incidence in black individuals; however, all races are now believed to be equally affected. [2]

Early reports suggested a male predominance. Larger series have since demonstrated an equal distribution between males and females. [2]

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.

Posso-De Los Rios CJ, Pope E. New insights into pustular dermatoses in pediatric patients. J Am Acad Dermatol. 2013 Dec 30. [Medline].

Dromy R, Raz A, Metzker A. Infantile acropustulosis. Pediatr Dermatol. 1991 Dec. 8(4):284-7. [Medline].

Good LM, Good TJ, High WA. Infantile acropustulosis in internationally adopted children. J Am Acad Dermatol. 2011 Oct. 65 (4):763-71. [Medline].

Tucker M, Ramolia P, Wells MJ. JAAD Grand Rounds. Neonate with extensive papulovesicles. J Am Acad Dermatol. 2013 May. 68 (5):877-9. [Medline].

Vicente J, Espana A, Idoate M, et al. Are eosinophilic pustular folliculitis of infancy and infantile acropustulosis the same entity?. Br J Dermatol. 1996 Nov. 135(5):807-9. [Medline].

Braun-Falco M, Stachowitz S, Schnopp C, et al. Infantile acropustulosis successfully controlled with topical corticosteroids under damp tubular retention bandages. Acta Derm Venereol. 2001 May. 81(2):140-1. [Medline].

Humeau S, Bureau B, Litoux P, Stalder JF. Infantile acropustulosis in six immigrant children. Pediatr Dermatol. 1995 Sep. 12(3):211-4. [Medline].

Silverberg NB. Infantile Acropustulosis. Silverberg NB, Durán-McKinster C, Tay YK, eds. Pediatric Skin of Color. New York, NY: Springer; 2015. 4(36): 323-25.

Kimura M, Higuchi T, Yoshida M. Infantile acropustulosis treated successfully with topical maxacalcitol. Acta Derm Venereol. 2011 May. 91 (3):363-4. [Medline].

Porriño-Bustamante ML, Sánchez-López J, Aneiros-Fernández J, Burkhardt P, Naranjo-Sintes R. Recurrent pustules on an infant’s scalp with neonatal onset. Int J Dermatol. 2015 Aug 12. [Medline].

Zhang X, Hunzelmann N, Tantcheva-Poor I. Recurrent sterile pustules and papules in a 7-month-old infant. Pediatr Dermatol. 2013 Sep-Oct. 30 (5):621. [Medline].

Ghosh S. Neonatal pustular dermatosis: an overview. Indian J Dermatol. 2015 Mar-Apr. 60 (2):211. [Medline].

Christine Shanahan University of Virginia School of Medicine

Christine Shanahan is a member of the following medical societies: American Telemedicine Association, Medical Society of Virginia

Disclosure: Nothing to disclose.

Barbara B Wilson, MD Edward P Cawley Associate Professor, Department of Dermatology, University of Virginia School of Medicine

Barbara B Wilson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Medical Society of Virginia, Sigma Xi

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association

Disclosure: Nothing to disclose.

Howard Pride, MD Associate Physician, 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

Disclosure: Nothing to disclose.

Pediatric Acropustulosis

Research & References of Pediatric Acropustulosis|A&C Accounting And Tax Services
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Pediatric Acropustulosis

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