Pediatric Acropustulosis

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.

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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

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