Acropustulosis of infancy

Acropustulosis of infancy is an uncommon condition characterised by small, itchy blisters and pustules on the palms and soles affecting children in the first 2-3 years of life.

This chapter is set out as follows:

• In some cases acropustulosis of infancy is preceded by scabies and may represent an allergic reaction to the scabies mite but in other cases there is no history of scabies

• In the majority of cases the onset is in the first year of life, particularly during the first 6 months

• Lesions are very itchy

Distribution

• Principally the soles, sides of the feet, and palms, but the dorsa of the feet, hands and fingers, as well as the ankles, wrists and forearms may also be affected. Scattered lesions can also be seen at other sites

Morphology

• Lesions arise in crops as small, red papules, which evolve into vesicles and then pustules over about 24 hours. Excoriation results in erosions and then crusts. Lesions heal with temporary hyperpigmentation

• Crops tend to occur at intervals of 2–4 weeks, often being more frequent and more numerous in the summer - each crop lasts for 7–14 days

• Laboratory tests are not needed for diagnosis but may be done to rule out an infectious cause

• Treatment is with a potent topical corticosteroid, eg Betnovate ® (betamethasone valerate 0.1%), with or without occlusion (Clingfilm can be a very effective form of occlusion for the feet, whereas cotton gloves are preferable for the hands)

• Dapsone has been used in a few severe cases under the supervision of a specialist

• Attacks occur with gradually diminishing numbers of lesions, and with decreasing frequency, until they cease altogether, usually within two years of the onset