An 18-month-old boy with erythematous eruption: Case report
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An 18 month old healthy black boy presented with a three week history of an erythematous, edematous eruption, which began around his elbows and knees and spread to involve his cheeks, the extensor aspects of his upper and lower extremities, and his buttocks. Mother reported that he developed an upper respiratory infection two weeks prior that had since resolved. The lesions were asymptomatic. On exam, involving his cheeks, forehead, nose, and extensor aspects of his extremities – with remarkable sparing of the trunk – are innumerable discrete and coalescing 2 – 10 millimeter erythematous, edematous monomorphic papules and papulovesicles. A few are centrally crusted. They tend to line up in areas of trauma, such a scratches.

The patient was diagnosed with Gianotti-Crosti syndrome, or papular acrodermatitis. This syndrome is a benign, self-limited eruption composed of erythematous, edematous papules involving the face, extremities and buttocks. The incidence is unknown, likely due to underreporting of the disease. Children between the ages of 1 and 6 are usually affected.

A few lesions on the trunk do not rule out GCS. The lesions may develop a hemorrhagic crust or scale and may be seen at sites of trauma (Koebner phenomenon). Patients are usually asymptomatic or may complain of mild pruritus. The lesions can last up to eight to 12 weeks. Patients with GCS may have several systemic findings prior or in addition to the skin lesions, including fever, malaise, upper respiratory symptoms, diarrhea, lymphadenopathy, lymphocytosis or lymphopenia, and rarely hepatosplenomegaly.

Vaccines reported to be associated with GCS include Haemophilus, oral polio, measles-mumps-rubella, diphtheria- pertussis-tetanus, hepatitis B and Japanese B encephalitis vaccines. Due to the prolonged course and striking presentation of GCS, reassurance is an important aspect of therapy. Most patients are asymptomatic and require only supportive care. Moderate potency topical steroids may help; however, worsening of lesions has also been reported. Topical preparations with menthol, camphor or praxomine or the administration of oral anti-histamines can be used in patients with pruritus.

Post-inflammatory hypo- or hyperpigmentation may develop and persist for several months after the lesions have resolved. The ability of the physician to recognize this common childhood exanthem may help to reassure families of its benign nature in the great majority of those affected.