Acrodermatitis

Definition

Acrodermatitis is a childhood skin condition that may be accompanied by mild symptoms of fever and malaise. It may also be associated with hepatitis B and other viral infections.

Alternative Names

Papular acrodermatitis of childhood; Gianotti-Crosti syndrome; Acrodermatitis - infantile lichenoid; Acrodermatitis - papular infantile; Papulovesicular acro-located syndrome

Causes, incidence, and risk factors

The cause of acrodermatitis is poorly understood, but its link with other infections is well- documented.

In Italian children, acrodermatitis is seen frequently with hepatitis B, but this link is rarely seen in the United States. Epstein-Barr virus (EBV, mononucleosis) is the virus most often associated with acrodermatitis. Other associated viruses inclcude, cytomegalovirus, coxsackie viruses, parainfluenza virus, respiratory syncytial virus (RSV), and some live virus vaccines.

A rare, genetic form of acrodermatitis is acrodermatitis enteropathica. In this disorder, zinc is poorly absorbed from the diet. Adding zinc supplements to the diet improves the condition. This form of the disorder can be associated with other abnormalities and development delays.

Symptoms

• Rash or patch on skin
• Brownish-red or copper-colored patch that is firm and flat on top
• String of bumps may appear in a line
• Generally not itchy
• Rash looks the same on both sides of the body
• Rash may appear on the palms and soles -- it does not occur on the back, chest, or belly area (this is one of the ways it is identified -- by the absence of the rash from the trunk of the body)

Other symptoms that may appear include:

• Swollen abdomen
• Swollen lymph nodes
• Tender lymph nodes

Signs and tests

Your doctor can diagnosed this condition by simply looking at the skin and rash. The liver, spleen, and lymph nodes may be swollen.

The following tests may be done to confirm the diagnosis or rule out other conditions:

• Bilirubin level
• Hepatitis virus serology or hepatitis B surface antigen
• Liver enzymes (liver function tests)
• Screening for EBV antibodies
• Serum zinc level may be tested in acrodermatitis enteropathica
• Skin biopsy

Treatment

Acrodermatitis by itself is not treated. Infections associated with this condition, such as hepatitis B and Epstein-Barr, should be treated appropriately.

Acrodermatitis enteropathica improves when zinc levels are returned to normal.

Expectations (prognosis)

Acrodermatitis usually disappears on its own without treatment or complication. However, the associated conditions must be watched carefully.

Complications

Complications occur as a result of associated conditions, rather than as a result of acrodermatitis.

Calling your health care provider

Call your health care provider if your child has signs of this condition.

References

More JG. Nutritional Dermatoses. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th Ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 670.

Browning J, Levy M. Papules, Nodules, and Ulcers. In: Long SS, Pickering LK, Prober CG. Principles and Practice of Pediatric Infectious Diseases.3rd ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008: chap 77.