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Acropustulosis of infancy - Skin
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Acropustulosis of infancy - Skin

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Contributors: Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH, Nancy Esterly MD
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Synopsis

Acropustulosis of infancy (AI) is a recurrent, self-limited, pruritic vesiculopustular eruption of the hands and feet, typically beginning during the first weeks to months of life.

Characteristically, lesions appear as recurrent crops every couple weeks to months, anywhere on hands and feet but more extensively on the palms and soles. Frequently, the condition is initiated by a scabies infestation.

Codes

ICD10CM:
P83.88 – Other specified conditions of integument specific to newborn

SNOMEDCT:
239098009 – Infantile acropustulosis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • A history of recurrent crops of pustules on the hands and feet is highly suggestive of AI; in the absence of a characteristic history, other diagnoses should be considered.
  • Scabies infestation in infants may present identically to AI and may precipitate the disease. Often, burrows will be obscured by vesiculation; careful examination of the entire infant for a typical burrow or vesicular or nodular lesions on the torso is necessary. Family members should also be questioned and examined for pruritus and burrows.
  • Eosinophilic folliculitis occurs mainly on the scalp rather than the hands and feet but may cycle concurrently with AI.
  • Congenital candidiasis, erythema toxicum neonatorum, and transient neonatal pustular melanosis are less pruritic and usually more widespread than AI.
  • Hand-foot-and-mouth disease usually affects children after age 1 and is associated with constitutional symptoms and oral lesions. The palmar and plantar vesicles are nonpruritic, more oval shaped, and oriented along dermatoglyphics.
  • The pustules of pustular psoriasis, bacterial pustulosis, and pustular tinea pedis are less well defined and often coalescent, as opposed to the well-defined 2-4 mm pustules of AI.

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Therapy

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References

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Last Updated: 08/14/2013
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Acropustulosis of infancy - Skin
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Acropustulosis of infancy : Acral, Pustule
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