Infantile acropustulosis

Infantile acropustulosis (IA) is a relatively rare disease characterized by recurrent episodes of pruritic vesicles and pustules, which develop in an acral distribution in young children (1)

• IA was first described in 1979 as a pruritic vesiculopustular eruption on the palms and soles (2, 3)
• recurrent crops of itchy vesicopustules appear on the palms and soles (1)
• attacks decrease gradually, usually within a few years of onset, but in the summer months in particular flares can be severe and the symptoms difficult to treat
• aetiology is unknown
  • a relationship with scabies has been reported (4, 5), but the aetiology of IA remains unknown. IA is a self-limiting disease, but the recurrent appearance of pruritic pustules can be distressing for children.
• more frequently seen in children with racially pigmented skin.
• characterised by intensely itchy vesicopustules on the soles and palms - usually occurs in the first year of life.
• attacks occur with decreasing frequency and generally resolve by the time the child is three years of age.
• scabies should be excluded
• treatment remains controversial
  • topical glucocorticoids have often been used with temporary improvement (4), and occlusive dressing therapy with topical glucocorticoids has been reported as effective in one case (6)
  • systemic administration of dapsone has been reported to be effective (3), but could be difficult to apply for small children
  • treatment with 0.0025% maxacalcitol ointment (an active form of D3) has been used in this condition

Click here for an example image of this condition

Reference:

• Vignon-Pennamen M-D, Wallach D. Infantile acropustulosis. Arch Dermatol 1986; 122: 1155-1160.
• Jarratt M, Ramsdell W. Infantile acropustulosis. Arch Dermatol 1979; 115: 834-836.
• Kahn G, Rywlin AM. Acropustulosis of infancy. Arch Dermatol 1979; 115: 831-833.
• Prendiville JS. Infantile acropustulosis -how often is it a sequela of scabies? Pediatr Dermatol 1995; 12: 275-276.
• Mancini AJ, Frieden IJ, Paller AS. Infantile acropustulosis revised: history of scabies and response to topical corticosteroids. Pediatr Dermatol 1998; 15: 337-341.
• Braun-Falco M, Stachowitz S, Schnopp C, Ring J, Abeck D. Infantile acropustulosis successfully controlled with topical corticosteroids under damp tubular retention bandages. Acta Derm Venereol 2001; 81: 140-141.