Infantile acrolocalized papulo-vesicular syndrome L44.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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History
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Crosti and Gianotti, 1967

Definition
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Skin changes similar to Acrodermatitis papulosa eruptiva infantilis without accompanying viral hepatitis on the basis of other viral infections or preceding immune stimulation (vaccinations).

Etiopathogenesis
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Unknown, possibly infection-allergic dermatosis of polyätiological origin. Especially described in Epstein-Barr virus, Coxsackie B, cytomegaly, para-influenza virus infections. Occasional detection of Cocksackie-Virus A16 from throat rinsing water or stool.

Manifestation
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Occurs in childhood, especially in spring and autumn. Preferably infants of the male sex aged 2 to 6 years.

Localization
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Mainly cheeks, extremities, palmae and plantae, elbows, hollow of the knee, also trunk.

Clinical features
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Symmetrical exanthematic eruptions of hemispherical, succulent, pink to purple, papular, partially papulovesicular appearing efflorescences with possible hemorrhagic note. Tendency to confluence. Within a few days the eruptions rise from caudal to cranial: lower extremities (with recess of the popliteal fossa) > buttocks > trunk > extensor sides of the upper extremities (with recess of the crook of the arm) > face with recess of the periocular and nasolabial region. Polylymphadenitis, possibly lasting several months.

Histology
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Edema in the upper corium, spongiotic loosening, microbubbles, mild acanthosis with hyperkeratosis, papillary body edema. Fine tissue picture of chronic vasculitis.

Differential diagnosis
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External therapy
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Under blander external therapy, e.g. with lotio alba, usually healing within a few weeks. Otherwise symptomatic treatment of the virus infection.

Progression/forecast
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Mostly healing after 1-2 months, rarely relapses.

Literature
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  1. Baldarini U et al (1994) An epidemic of infantile papular acrodermatitis (Gianotti-Crosti syndrome) due to Epstein-Barr virus. Dermatology 188: 203-204
  2. Crone J et al (2002) Acrodermatitis enteropathica-like eruption as the presenting sign of cystic fibrosis--case report and review of the literature. Eur J Pediatr 161: 475-478
  3. Crosti A, Gianotti F (1967) Infantile papular acrodermatitis and lymphoreticulotropic viruses. Minerva Dermatol 42: 264-278
  4. Haug S et al (2002) Gianotti-Crosti syndrome following immunization. dermatologist 53: 683-685
  5. Müller K, Heüveldop A, Schulz H (1990) Epstein-Barr virus-associated infantile acrolocalized papulo-vesicular syndrome (Gianotti-Crosti syndrome). Close to the skin Paed 3: 4-8
  6. Ricci G et al (2003) Gianotti-Crosti syndrome and allergic background. Acta Derm Venereol 83: 202-205
  7. Schopf RE (1995) Gianotti-Crosti syndrome in Epstein-Barr virus infection. dermatologist 46: 714-716
  8. Virgili A et al (2003) Acroangiodermatitis of amputation blunt. Eur J Dermatol 13: 402-403

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Last updated on: 29.10.2020