Derm Dx: Pink to flesh-colored papules on a young child - Clinical Advisor

Derm Dx: Pink to flesh-colored papules on a young child

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  • DermDx_081217_GionattiCrosti_v2

The patient is a 17-month-old Hispanic female with a 6-week history of a rash most prominent on her arms and legs. She was normally developed and afebrile. She had no lymphadenopathy or hepatosplenomegaly. A complete blood count reveals slight leukocytosis. Examination reveals multiple pink to flesh-colored papules and papulovesicles primarily of her extremities and buttocks.

Gianotti-Crosti syndrome (GCS) is a benign, self-limited disorder seen primarily in children between the ages of 3 months to 15 years of age, with the majority of cases occurring in those aged 1 to 6 years.1,2 The condition rarely occurs...

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Gianotti-Crosti syndrome (GCS) is a benign, self-limited disorder seen primarily in children between the ages of 3 months to 15 years of age, with the majority of cases occurring in those aged 1 to 6 years.1,2 The condition rarely occurs in adults. In the US, it has been linked to vaccinations and Epstein-Barr virus, and in Europe to hepatitis B infection. An aberrant immunologic response is believed responsible for GCS.3

The rash has an abrupt onset consisting of multiple pink to red-brown papules or papulovesicles. The distribution is symmetric, occurring on the face, buttocks, and extensor surfaces. The oral mucosa is not involved, and the trunk is usually spared. The rash is typically asymptomatic, but some cases can have mild pruritus.

The differential diagnosis includes insect bites and viral exanthems. GCS is self-limiting, and many cases do not require treatment. For patients experiencing pruritus, topical steroids are often of benefit and may promote resolution. The rash lasts 10 days to 2 months and may result in temporary post-inflammatory hyperpigmentation.2 Recurrence of the condition is unlikely.4

Rebecca Geiger, PA-C, is a physician assistant on staff at the DermDox Dermatology Center in Hazleton, 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.

References

  1. Shaath T, Kroshinsky D. Gianotti-Crosti syndrome-like reaction. J Am Acad Dermatol. 2016;74(Suppl 1):AB162.
  2. Brandt O, Abeck D, Gianotti R, Burgdorf W. Gianotti-Crosti syndrome. J Am Acad Dermatol. 2006;54:136-145.
  3. Caltabiano R, Vecchio GM, De Pasquale R, Loreto C, Leonardi R, Vasquez E. Human ß-defensin 4 expression in Gianotti-Crosti. Acta Dermatovenerol Croat. 2013;21:43-47.
  4. Metelitsa AI, Fiorillo L. Recurrent Gianotti-Crosti syndrome. J Am Acad Dermatol. 2011;65:876-877.
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