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Papular Acrodermatitis

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Papular Acrodermatitis, Gianotti-Crosti Syndrome

  • See Also
  1. Viral Exanthem
  • Epidemiology
  1. Ages 6 months to 12 years (most common in age <4-6 years, and rare in adults)
  2. Most common in spring and summer (often with a cluster of cases)
  • Pathophysiology
  1. Inflammatory reaction surrounding vessels (perivascular lymphocytic infiltrate)
  • Risk Factors
  1. Atopic disease history or Family History
  • Causes
  1. Viral Infections (most common)
    1. Epstein-Barr Virus (EBV, Mononucleosis)
      1. Most common cause
    2. Hepatitis BVirus
      1. Had been most common cause prior to Hepatitis B Vaccine
    3. Hepatitis A Virus
    4. Cytomegalovirus (CMV)
    5. Enteroviruses
    6. Echoviruses
    7. cCoxsackievirus
    8. Respiratory Syncytial Virus (RSV)
    9. Influenza Virus
    10. Parainfluenza VIrus
    11. Covid19
    12. Human Herpesvirus 6
    13. HIV Infection
    14. Mumps
    15. Parvovirus B19
    16. Poxviruses
    17. Rotavirus
  2. Vaccinations
    1. Influenza Vaccine
    2. BCG vaccine
    3. DPT Vaccine
    4. Polio Vaccine
    5. Hepatitis B Vaccine
    6. Japanese EncephalitisVaccine
    7. MeaslesVaccine
  • Symptoms
  1. Non-pruritic papular rash accompanying Viral Infections
  • Findings
  1. Symmetric rash, progressing over a 3-4 day course and persisting >10 days
    1. Onset on buttocks and thighs
    2. Develops on extensor arms including palms
      1. Extensor legs and foot soles may also be involved
    3. Ultimately involves face (esp. cheeks)
    4. Resolves over 2 to 8 weeks (rare recurrence)
  2. Papules
    1. Diameter 5-10 mm
      1. Younger children have larger lesions than older children
    2. Color starts as dull red, becoming deep red and may appear purple
    3. Small Vesicles may develop
  3. Associated findings
    1. Lymphadenopathy inguinal and axillary (resolves over weeks to months)
  • Differential Diagnosis
  1. Viral Exanthem
  • Management
  1. Symptomatic management only
  2. May apply skin Emollients
  3. Short-term, low potency Topical Corticosteroids may be considered
  • References
  1. Snowden (2024) Papular Acrodermatitis, StatPearls
    1. https://www.ncbi.nlm.nih.gov/books/NBK441825/
  2. Oakley (2015) Papular Acrodermatitis of childhood, DermNet
    1. https://dermnetnz.org/topics/papular-acrodermatitis-of-childhood