Acropustulosis of infancy (AI)

Question 1

What is AI?

Answer 1

Acropustulosis of infancy: recurrent, pruritic and pustular eruption commonly involving hands and feet

Question 2

AI, natural course

Answer 2

Lesions start at 2-3 months of age
Remain for 1-3 weeks
Frequent recurrences every few weeks to months
Severity gradually declines
Resolution around 3 y

Question 3

AI etiology

Answer 3

Unknown
Can happen after Scabies infection, especially in the developing world, but the connection is still unclear
Frequently seen in international adopted children, who lived in crowded and unsanitary conditions that predisposed them to Scabies infection

Question 4

AI Clinical findings

Answer 4

Well-circumscribed, round, vesiculopustular lesions in an acral distribution (mc palms and soles)
Highly pruritic
Present for 1-3 wk with frequent recurrences
Healed lesions –> postinflammatory hyperpigmentation + scaling
**NO scabies mites or burrows seen

Question 5

AI, Differential Dx

Answer 5

Broad, can be confused with:

Scabies, dyshidrotic eczema, Transient Neonatal Pustular Melanosis (TNPN), Impetigo, HFMD

Question 6

AI vs Scabies

Answer 6

Scabies can happen at any age
Highly inflammatory, serpiginous or J-shaped burrows with papules and nodules
Family members can be affected
Not recurrent if properly treated

Question 7

AI vs dyshidrotic eczema

Answer 7

"Pompholyx"
Recurrent bullous or vesicular eruption commonly affecting the palmoplantar skin bilaterally
Intense pruritus
*can present at any age
*likely to have tense bulla formation

Question 8

AI vs TNPN

Answer 8

TNPN presents at birth
Vesicopustular lesions that easily rupture 24-48 h after onset –> hyperpigmented macules
Common in trunk and extremities, but no acral dist
Not recurrent
Usually asymptomatic

Question 9

AI vs Impetigo neonatorum

Answer 9

Seen in the NB period
Superficial pustules, vesicles and bullous lesions
Usually on face and flexural surfaces
Culture + Staphylococcus Aureus

Question 10

AI vs HFMD

Answer 10

By Coxsackie virus
Distinctive, symmetric 2-4 mm round clustered papulovesicles –> crusted on an erythematous base
Distal extremities (palms, soles), buttocks, around mouth
Occurs most densely in areas where skin is injured: patches of eczema, burns, areas of minor trauma
Often aymptomatic, but maybe pruritic
NOT recurrent

Question 11

AI management

Answer 11

1st line Tx: moderate to high potency topical CS (1-2 wk), then PRN for recurrences
Systemic antihistamines for pruritus relief