Syn .: Acrodermatitis papulosa eruptive infantilis, papular acrodermatitis of childhood, papulovesicular acrolocated syndrome.
Def .: Suddenly appearing erythematous papular rash, symmetrically distributed over the face, buttocks and limbs of children.
Epid .: A rare disease, most often occurs in children between 3 months and 15 years of age, with the peak incidence between 1 and 6 years of age, sometimes it can also appear in adults.
Etiol .: The disease is associated with infection with the following viruses: hepatitis A, B, C (HAV, HBV, HCV), Epstein-Barr (EBV), cytomegalovirus (CMV), Coxasackie A16, B4, B5, Herpes simplex 6, rota enteroviruses (HRV), poxviruses (molluscum contagiosum), parvovirus B19, parainfluenza, rubella, mumps, echoviruses, HIV and streptococcal bacterial infection, Mycobacterium avium-intracellulare, Mycoplasma pneumoniae, Borrelia burgdorferi, Bartonella henselae. The appearance of lesions has also been reported after BCG vaccination, as well as after vaccinations against polio, diphtheria, pertussis, measles-mumps-rubella, and influenza.
Pat: The pathogenesis of the syndrome is still completely unclear, however, it is believed that viral infection is the most important trigger, which perhaps, with the participation of other factors, stimulates an immune response, in the mechanism of immune complexes or a T-cell response. The disease often affects atopic children.
Loc .: The lesions are located symmetrically on the upright surfaces of the limbs, on the buttocks, cheeks, rarely on the trunk, they do not occur on the mucous membranes.
Clinical rash, monomorphic rash composed of flat lumps, sometimes lumpy-vesicles that do not fuse together. Eruptions are 1-10 mm in diameter, symmetrically located on the cheeks, buttocks, and extensible parts of the limbs, they persist for at least 10 days. Köbner’s symptom is usually positive, pruritus is unlikely to occur. Before the onset of rash, approximately 30% of children had symptoms of respiratory tract infection, enlarged lymph nodes, liver enlargement, fever, malaise, diarrhea and a feeling of constant fatigue. Table Z-3 presents the diagnostic criteria of the syndrome.
Hist .: Nonspecific, there may or may not be bubbles in the hitopathological picture. In the presence of vesicles in the epidermis, there is hyperkeratosis, slight acanthosis and a spongy state with the presence of a large number of vesicles. In the absence of vesicles in the epidermis, slight acanthosis, focal parakeratosis and a spongy state are found. In the dermis, there is swelling of the papillae and perivascular inflammatory infiltrates, mainly composed of lymphocytes. Occasionally, significant exocytosis of lymphocytes into the epidermis may be present, reminiscent of Pautrier’s microoptions in mycosis fungoides. Occasionally, the histological picture may show lichen-like dermatitis or lymphocytic vasculitis with the presence of ecchymosis.
DL: Blood tests for antibodies or viral antigens, lymphocytosis or lymphopenia may be present in the blood. Sometimes the number of monocytes is increased, especially in patients with EBV. Liver enzymes may be elevated.
DR: Lichen planus, Erythema exudative multiforme, Erythema infectious, Gibert’s pink dandruff, lichen-like drug rash, scabies, papular urticaria. Slightly less common rash in infectious mononucleosis and other viral infections, band lichen, lichen-like dandruff (acute paroriasis), lichen-like rubbing dermatitis, Henoch-Schönlein purpura, atopic dermatitis.
Healing: Liquid powder, neutral creams and ointments, generally antihistamines.
Year: Good, changes usually disappear within 2-3 weeks, sometimes they may last up to 8 weeks.
Lit.: [1] Chuh A.: Diagnostic criteria for Gianotti-Crosti syndrome: a prospective case-control study for validity assessment. Cutis 2001, 68; 207-213. [2] Andiran N., Sentruk G.B., Bukulmez G.: Combined Vaccination by measles and hepatitis B vaccines: a new cause of Gianotti-Crosti syndrome. Dermatology 2002, 204; 75-6. [3] Brandt O., Abeck D., Gianotti R.: Gianotti-Crosti syndrome. J Am Acad Dermatol 2006, 54; 136-145.
Source: A. Kaszuba, Z. Adamski: “Lexicon of dermatology”; XNUMXst edition, Czelej Publishing House