Images (1)

Acropustulosis of infancyL44.4

Author:Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 09.01.2024

Dieser Artikel auf Deutsch

Synonym(s)

acropustulosis infantilis; acropustulosis of infancy; infantile acropustulose; Infantile acropustulose; infantile acropustulosis

Requires free registration (medical professionals only)

Please login to access all articles, images, and functions.

Our content is available exclusively to medical professionals. If you have already registered, please login. If you haven't, you can register for free (medical professionals only).


Requires free registration (medical professionals only)

Please complete your registration to access all articles and images.

To gain access, you must complete your registration. You either haven't confirmed your e-mail address or we still need proof that you are a member of the medical profession.

Finish your registration now

HistoryThis section has been translated automatically.

Kahn and Rywlin, 1979

DefinitionThis section has been translated automatically.

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.

EtiopathogenesisThis section has been translated automatically.

Unexplained; possible triggers are atopic diathesis and scabies (persistent immune reaction in a previous scabies infection).

ManifestationThis section has been translated automatically.

Usually begins in the first months of life, manifestation peak in infants and toddlers, rarely connatal.

LocalizationThis section has been translated automatically.

Palms of hands, soles of feet; also on the dorsal sides of hands and feet. Rarely, and then only sporadically, pustulation of the trunk, buttocks or capillitium.

Clinical featuresThis section has been translated automatically.

Disseminated, inflammatory reddened papules rapidly transform into papulovesicles and finally into pustules and subsequently into crusty lesions. No confluence. Regression within 1-2 weeks. Severe itching. Chronic recurrent course with disease careers of up to 3 years. In the last phase of the disease, the intervals without appearance are prolonged, while at the same time the acuteity of the disease flattens.

HistologyThis section has been translated automatically.

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

DiagnosisThis section has been translated automatically.

Clinical signs (acral localization, severe itching, intermittent course) and medical history are diagnostic.

Differential diagnosisThis section has been translated automatically.

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

Further differential diagnoses:

TherapyThis section has been translated automatically.

Self-limiting course; causal therapy not known. Parents should be informed in detail about benignity and the particularities of the clinical course.

External therapyThis section has been translated automatically.

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.

Internal therapyThis section has been translated automatically.

Therapy with DADPS (1.0-3.0 mg/kg bw/day) successful, but only to be used with a self-limited clinical picture under strict indication (Met-Hb formation, haemolysis!). Recurrence at weaning.

Progression/forecastThis section has been translated automatically.

Spontaneous healing between the ages of 2 and 4.

Case report(s)This section has been translated automatically.

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.

LiteratureThis section has been translated automatically.

  1. Braun-Falco M et al (2003) Palmoplantar vesicular lesions in childhood. Dermatologist 54: 156-159
  2. Ferreira S et al (2020) Infantile acropustulosis. J Paediatr Child Health 56:1165-1166.
  3. Good LM et al (2011) Infantile acropustulosis in internationally adopted children. J Am Acad Dermatol 65:763-771
  4. Hürlimann AF, Wüthrich B (1992) Infantile acropustulosis. Z Hautkr 67: 1073-1079
  5. Kahn G, Rywlin AM (1979) Acropustulosis of infancy. Arch Dermatol 115: 831-833
  6. Klein CE et al (1989) Infantile acropustulosis. Dermatologist 40: 501-503
  7. Mazereeuw-Hautier J (2004) Infantile acropustulosis. Press Med 33:1352-1354.
  8. Meiss F et al (2008) Infant with pustules on both plantae. Dermatology 59: 323-324
  9. Paloni G et al (2013) Acropustulosis of infancy. Arch Dis Child Fetal Neonatal Ed 98:F340.

Authors

Last updated on: 09.01.2024

Author: Prof. Dr. med. Peter Altmeyer