Papular-purpuric gloves and socks syndrome
A flu-like prodrome of fever, myalgia, lymphadenopathy, and malaise can precede or occur simultaneously with the distinctive cutaneous manifestations. Rapidly progressive, extremely pruritic erythema and swelling of the hands and feet are characteristic. Papular purpura then develops, covering the dorsal and palmoplantar aspects of the hands and feet with sharp demarcation at the wrists and ankles, giving the appearance of being covered by gloves or socks. Patients may report burning and itching.
Most patients also develop an enanthem, which may aid in diagnosis. PPGSS is a self-limited disease, and therapy consists of supportive care and maintenance of adequate fluid intake.
L98.8 – Other specified disorders of the skin and subcutaneous tissue
402920006 – Papular purpuric gloves and socks syndrome
Differential Diagnosis & Pitfalls
- Meningococcal infection – Petechiae may be the earliest sign. Purpuric lesions usually become confluent and necrotic in the center. Patients will report neurologic symptoms. Cerebrospinal fluid (CSF) and blood cultures aid in confirming the diagnosis.
- Erythema multiforme – Lesions are targetoid.
- Gianotti-Crosti syndrome – Lesions are more monomorphic and widespread rather than acral and follow Epstein-Barr virus infection or hepatitis B virus infection.
- Immunoglobulin A (IgA) vasculitis (formerly Henoch-Schönlein purpura) – Often has acral distribution and is associated with arthritis and abdominal pain. Lesions are usually larger than in PPGSS. Medication history and history of recent infections of the aerodigestive tract may aid diagnosis.
- Hand-foot-and-mouth disease – Tender vesicles are more likely seen than in PPGSS.
- Chemotherapy-related painful acral erythema (Burgdorf syndrome)
- Kawasaki disease – Redness and swelling may be seen on the hands and feet prior to the desquamation that occurs during the second week of the illness.
PPGSS mainly affects young adults but has been reported in children and adolescents; it should be included in the differential diagnosis of childhood exanthems.