Derm Dx: Symmetrical pink papules on the cheeks, arms and legs - Clinical Advisor

Derm Dx: Symmetrical pink papules on the cheeks, arms and legs

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  • Gianotti-Crosti syndrome 1_0412 Derm Dx

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  • Gianotti-Crosti syndrome 3_0412 Derm Dx

A 3-year-old male presents with an eruption of pink papules on the cheeks, arms and legs that has been present for four days. The boy’s mother reports he has not been scratching the lesions.

Both the patient and his older sister had a recent cold, but the older sister does not have a rash. The mother thought the eruption was hives and has been giving the child oral anti-histamines, but there has been no improvement. She endorses using a new laundry detergent in the week prior to the outbreak, and states that she frequently brings her son to the park to play. There is no significant past medical history.

On exam the patient is a cute afebrile toddler in no acute distress. Physical exam is remarkable for symmetrically distributed pink papules on the cheeks and bilateral dorsal arms, forearms, thighs and legs. The trunk is spared. There is no evidence of excoriation. What’s your diagnosis?

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Gianotti-Crosti syndrome is a characteristic viral exanthem occurring mainly in children aged 1- to 6- years. An abrupt eruption of monomorphous pink-brown papules or papulovesicles characterize this exanthem, which is symmetrically distributed on the face, buttocks, forearms and extensor legs,...

Submit your diagnosis to see full explanation.

Gianotti-Crosti syndrome is a characteristic viral exanthem occurring mainly in children aged 1- to 6- years. An abrupt eruption of monomorphous pink-brown papules or papulovesicles characterize this exanthem, which is symmetrically distributed on the face, buttocks, forearms and extensor legs, but spares the trunk. 

Mild upper respiratory infection often preceeds exanthem. Pruritis is generally mild or absent, and the eruption persists for 10 days to many weeks, which is longer than most other exanthems. 

Historically, Gianotti-Crosti syndrome has been associated with hepatitis B infection. However, this association is extremely rare in the United States, where Epstein-Barr virus is the most common association. Numerous other viruses have also been implicated including cytomegalovirus, coxsackievirus, adenovirus, respiratory syncytial virus, parainfluenza virus, parvovirus B19, rotavirus and human herpes virus 6. 1-3    

Diagnosis                       

Diagnosis is based on the clinical appearance of the characteristic abrupt and symmetrical eruption of papules and papulovesicles in a stereotypical distribution on the cheeks, dorsal arms and legs, sparing the trunk.   

In general, routine laboratory studies for hepatitis are only indicated in patients for whom there is a clinical suspicion based on history and physical. 1-3                      

Treatment and prognosis           

Treatment is supportive, and parents should be educated that the skin lesions may take up to three months to completely resolve. 1-3   

Adam Rees, MD, and Audrey Chan, MD, are both residents in the Department of Dermatology at Baylor College of Medicine in Houston.  

References

1. Bolognia J , Jorizzo JL, and Rapini RP. “Chapter 80: Other Viral Diseases.” Dermatology. St. Louis, Mo.: Mosby/Elsevier, 2008.

2. James WD, Berger TG, Elston DE et al.  ” Chapter 19: Viral Diseases.” Andrews’ Diseases of the Skin: Clinical Dermatology. Philadelphia: Saunders Elsevier, 2006.

3. Paller A, Mancini AJ, Hurwitz S. “Chapter 16: Exanthematous Diseases of Childhood.” Hurwitz clinical pediatric dermatology: a textbook of skin disorders of childhood and adolescence. 3rd ed. Philadelphia: Elsevier Saunders, 2006.

 

 

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