Infantile Acropustulosis

A recurrent, self-limiting vesiculopustular eruption of infancy characterized by crops of pruritic pustules primarily affecting the palms and soles.

Key Points

Recurring eruptions of sterile pustules
Primarily affects distal extremities
Intensely pruritic
Onset typically 2-10 months of age
Episodic course with spontaneous resolution

Epidemiology & Risk Factors

Demographics

Age Distribution:
- Peak onset: 2-10 months of age
- Can begin in neonatal period
- Rarely persists beyond 3 years
- More severe in first year
Population Characteristics:
- Male predominance (2:1 ratio)
- More common in Black infants
- No geographic predilection
- Sporadic occurrence

Risk Factors

Potential Triggers:
- Prior scabies infection
- Family history of atopy
- Environmental factors (heat, friction)
- Possible genetic predisposition
Associated Conditions:
- Atopic dermatitis
- Other hypersensitivity disorders
- History of neonatal pustular disorders

Clinical Features

Cutaneous Manifestations

Primary Lesions:
- Vesicles and pustules:
  - 1-2 mm diameter
  - Symmetrical distribution
  - Grouped arrangement
  - Overlying erythematous base
- Evolution:
  - Begin as vesicles
  - Progress to pustules
  - Resolve with crusting
  - No scarring
Distribution Pattern:
- Primary Sites:
  - Palms
  - Soles
  - Dorsal hands and feet
- Secondary Sites:
  - Scalp
  - Face
  - Trunk (occasionally)
  - Extremities

Clinical Course

Episode Characteristics:
- Duration: 7-14 days
- Recurrence: Every 2-4 weeks
- Nocturnal exacerbation
- Spontaneous resolution between episodes
Associated Symptoms:
- Intense pruritus (hallmark)
- Irritability
- Sleep disturbance
- Discomfort with walking/crawling

Pathophysiology

Mechanisms

Inflammatory Process:
- Neutrophilic infiltration
- Subcorneal pustule formation
- Epidermal spongiosis
- Dermal edema
Proposed Pathways:
- Immune-mediated response
- Neutrophil chemotaxis
- Possible eosinophil involvement
- Inflammatory mediator release

Histopathological Features

Microscopic Findings:
- Subcorneal pustules
- Neutrophilic infiltrate
- Minimal spongiosis
- Superficial dermal edema
Special Studies:
- Negative for organisms
- Sterile pustules
- No viral inclusions
- No specific immunofluorescence

Diagnosis & Workup

Diagnostic Approach

Clinical Criteria:
- Age of onset
- Characteristic distribution
- Recurrent nature
- Typical morphology
Physical Examination:
- Complete skin examination
- Documentation of distribution
- Assessment of severity
- Exclusion of other conditions

Laboratory Studies

First-line Tests:
- Tzanck smear:
  - Neutrophilic predominance
  - No viral changes
- Gram stain and culture:
  - Usually negative
  - Rules out infection
Additional Studies (If Needed):
- Skin biopsy (rarely required)
- KOH preparation
- Viral studies
- Scabies examination

Differential Diagnosis

Common Considerations

Infectious:
- Scabies:
  - Burrows present
  - Family members affected
  - Different distribution
- Bacterial Infection:
  - More inflammation
  - Positive culture
  - Systemic symptoms possible
- Viral Infections:
  - Different morphology
  - Associated symptoms
Non-Infectious:
- Dyshidrotic Eczema:
  - Different age group
  - Vesicular pattern
- Pustular Psoriasis:
  - Associated findings
  - Different course
- Other Considerations:
  - TNPM
  - Miliaria
  - Erythema toxicum

Management & Treatment

Treatment Approach

First-Line Therapy:
- Topical Corticosteroids:
  - Mid-potency for flares
  - Short courses
  - Monitoring for side effects
- Antihistamines:
  - For pruritus control
  - Age-appropriate dosing
  - Combined H1 antagonists
Refractory Cases:
- Topical Dapsone:
  - 5% gel
  - Monitor for irritation
- Systemic Therapy:
  - Oral dapsone
  - Systemic corticosteroids (rarely)
  - Close monitoring required

Supportive Care

Skin Care:
- Gentle cleansing
- Regular moisturization
- Cool compresses
- Avoid irritants
Environmental Modifications:
- Temperature control
- Humidity management
- Loose clothing
- Cotton fabrics

Prognosis & Complications

Natural Course

Expected Timeline:
- Duration of condition: 1-3 years
- Gradual improvement
- Decreasing frequency
- Resolution by age 2-3 years
Monitoring Parameters:
- Episode frequency
- Severity assessment
- Treatment response
- Quality of life impact

Complications

Direct Complications:
- Secondary infection
- Sleep disturbance
- Irritability
- Developmental impact
Long-term Considerations:
- Post-inflammatory changes
- Psychological impact
- Family stress

Special Considerations

Quality of Life Impact

Patient Impact:
- Sleep disruption
- Activity limitation
- Comfort issues
- Developmental concerns
Family Impact:
- Parental stress
- Sleep deprivation
- Care burden
- Economic impact

Prevention Strategies

Trigger Avoidance:
- Temperature regulation
- Appropriate clothing
- Skin barrier maintenance
- Environmental modifications
Monitoring:
- Regular follow-up
- Early intervention
- Documentation
- Treatment adjustment

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.

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Infantile Acropustulosis