Derm Dx: A baby with a rash on the hands and feet - Clinical Advisor

Derm Dx: A baby with a rash on the hands and feet

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A 3-month-old Hispanic male is brought to the office by his mother for evaluation of an itchy rash located on the hands and feet. The child is otherwise healthy. On physical examination, scattered flesh-colored papules and pustules, some with slight overlying scale, are noted on his palms and soles. No similar lesions are noted elsewhere.

This patient has infantile acropustulosis, a disorder most often seen in the first year of life.1 The etiology is unknown; however, many cases follow infestation with scabies and id reaction is suspected.2 The condition is prevalent among internationally adopted children...

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This patient has infantile acropustulosis, a disorder most often seen in the first year of life.1 The etiology is unknown; however, many cases follow infestation with scabies and id reaction is suspected.2 The condition is prevalent among internationally adopted children who spent early infancy in crowded, unclean environments.3

Infantile acropustulosis manifests as recurrent crops of intensely pruritic papules, vesicles, and pustules on the palms, soles, wrists, and ankles. The initial eruption lasts for 1 to 2 weeks and can reappear several weeks later. Spontaneous remission frequently occurs within several months.4 Diagnosis is usually made based on clinical findings. Bacterial and viral cultures are negative, and histopathology of infantile acropustulosis reveals an intraepidermal pustule containing polymorphonuclear neutrophils and eosinophils.

When symptomatic, short-term treatment with mid- to high-potency topical steroids may promote resolution. Dapsone has been used in severe cases.5

John Pappas, BS, is a medical student at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Falanga V. Infantile acropustulosis with eosinophilia. J Am Acad Dermatol. 1985;13:826-828.
  2. Prendiville JS. Infantile acropustulosis—how often is it a sequela of scabies? Pediatr Dermatol. 1995;12:275-276.
  3. Good L, Good TJ, High WA. Infantile acropustulosis in internationally adopted children. J Am Acad Dermatol. 2011;65:763-771.
  4. Jennings JL, Burrows WM. Infantile acropustulosis. J Am Acad Dermatol. 1983;9:733-738.
  5. Kahn G, Rywlin AM. Acropustulosis of infancy. Arch Dermatol. 1979;115:831-833.

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