Acropustulosis of infancy L44.4

Rare, usually intensely itchy, intermittent (flare-up duration 2-3 weeks), time-limited sterile pustulosis of unknown origin occurring on the palms of the hands and soles of the feet. Episodic course with no symptoms for months. Spontaneous healing usually between the ages of 2 and 4.

Intraepidermal, mainly subcorneal, unilocular pustules with neutrophilic, sometimes also eosinophilic granulocytes. Perivascular round cell infiltrate in the upper dermis.

the most important differential diagnosis is superinfected scabies (mite detection necessary for differentiation)!

Further differential diagnoses:

• Transient neonatal pustular melanosis (similar clinical picture, characterized by lesional pigmentation)
• Impetigo contagiosa (detection of the pathogens)
• Syphilis connata (extremely rare today; serological evidence)
• Psoriasis pustulosa palmo-plantaris (very rare in newborns)
• impetiginized, dyshidrotic hand and foot eczema (extremely rare in newborns!).

Symptomatic, e.g. astringent shaking mixtures or ointments with oak bark or synthetic tanning agents (e.g. Tannolact cream, Tannosynt Lotio).

If the pustulation is very pronounced, application of weakly effective (possibly under-dosed) external glucocorticoids such as 0.5% hydrocortisone cream.

Alternatively a 2-3% polidocanol cream should be used.

The 7-month-old infant suffered since the 2nd month of life from relapsing-like pustular formations on both soles of the feet. The parents reported an agonizing itching, which regularly affected their postpartum rest. All local measures had been unsuccessful so far.

Findings: On both soles of the feet disseminated and grouped vesicles of 0.1-0.3 cm in size and pale yellow pustules on bright red erythema and plaques. Older lesions were characterized by a coarse lamellar scaling.

Diagnosis: No evidence of scabies. Pustule smear: Sterile. Histology: Detection of subcorneal unilocular pustules with neutrophil, sometimes eosinophilic granulocytes. Bulky, perivascular round cell infiltrate in the upper dermis.

Therapy: 0.5% hydrocortisone cream alternating with a 3% polidicanol cream.

Course: Further relapsing activities until 18 months of age. Afterwards, the relapses subside for another 3 months and healing takes place.

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