What is acropustulosis?

Answer 1

Infantile acropustulosis is a recurrent, self-limited, pruritic, vesicopustular eruption of the palms and the soles occurring in young children during the first 2-3 years of life. Newly described in 1979, it is probably much more common than the scarcity of reports would imply. The pathophysiology of infantile acropustulosis is unknown. Many cases are preceded by well-documented or suspected scabies infestation, and a scabies id reaction has been suggested. More often, cases occur despite scabies having been thoroughly ruled out. Bacterial and viral culture results are consistently negative, and negative immunofluorescence results suggest that infantile acropustulosis is not an antibody-mediated autoimmune process. All cases spontaneously resolve in a few months to 3 years. Early reports suggested a predominance of African Americans. Now, acropustulosis is believed to affect all races equally. Early reports suggested a male predominance. Larger series have since shown an equal distribution between males and females. Although children as old as 9 years have been reported, acropustulosis typically begins between the first 2-12 months of life. Resolution by age 3 years is the norm. * The classic history is an infant aged 2-12 months developing pruritic erythematous macules or papules that progress into vesicles and then pustules. * Children are fretful, irritable, and obviously uncomfortable, but otherwise healthy. * Individual bouts last 7-15 days and recur in 2- to 4-week intervals. * Often, children have been empirically treated with antiscabies medicines prior to presentation. * The intensity and the duration of attacks diminish with each recurrence. * The hands and the feet are always involved, usually on the palms, the soles, and the lateral surfaces. Lesions may occur on the dorsal aspects of the hands and the feet as well as the trunk, the scalp, and the face. * Lesions begin as small macules or papules that then form distinct, noncoalescing vesicles and pustules. * They heal with macular hyperpigmentation. * No other organ systems are involved. The cause of infantile acropustulosis is unknown. Scabies as a preceding or concomitant infestation is well documented in some cases. Many children are undoubtedly misdiagnosed as having scabies and treated with lindane or permethrin without any confirmatory scrapings. No other infectious agent has been documented.