Acropustulosis of infancy
The etiology is not fully elucidated; however, it is thought by some authors to represent a post-scabetic phenomenon.
Acropustulosis of infancy may wax and wane for years with pruritic lesions recurring initially every few weeks, then every few months, with the duration and intensity of episodes diminishing over time, ultimately resolving completely.
L40.3 – Pustulosis palmaris et plantaris
239098009 – Infantile acropustulosis
Differential Diagnosis & Pitfalls
- Scabies infection in infants may present identically to acropustulosis and is thought by many authors to precipitate the condition. Often, burrows will be obscured by vesiculation. Careful examination of the entire infant for a typical burrow, papules, or nodules on the torso is necessary. Family members should also be questioned and examined for (nocturnal) pruritus and burrows.
- Impetigo – Vesicles, bullae, pustules, and erosions with honey-colored crust. Usually asymmetric and not acral. Impetiginization of acropustulosis may occur secondary to scratching.
- Eosinophilic folliculitis occurs mainly on the scalp rather than the hands and feet but may cycle concurrently with acropustulosis.
- Congenital candidiasis, erythema toxicum neonatorum, and transient neonatal pustular melanosis are less pruritic and usually more widespread than acropustulosis.
- Hand-foot-and-mouth disease usually affects children older than 1 year and is associated with constitutional symptoms and oral lesions. The palmoplantar vesicles are nonpruritic, more oval, and oriented along dermatoglyphs.
- Arthropod assault by Solenopsis spp (fire ants) presents distinctly with acral pustules similar to acropustulosis; however, tenderness and a relevant history of exposure help tease this out.
- The pustules of pustular psoriasis and pustular tinea pedis are less well-defined and often coalescent, as opposed to the well-defined, 2- to 4-mm pustules of acropustulosis.