II. Epidemiology
- Ages 6 months to 12 years (most common in age <4-6 years, and rare in adults)
- Most common in spring and summer (often with a cluster of cases)
III. Pathophysiology
- Inflammatory reaction surrounding vessels (perivascular lymphocytic infiltrate)
IV. Risk Factors
- Atopic disease history or Family History
V. Causes
-
Viral Infections (most common)
- Epstein-Barr Virus (EBV, Mononucleosis)
- Most common cause
- Hepatitis BVirus
- Had been most common cause prior to Hepatitis B Vaccine
- Hepatitis A Virus
- Cytomegalovirus (CMV)
- Enteroviruses
- Echoviruses
- cCoxsackievirus
- Respiratory Syncytial Virus (RSV)
- Influenza Virus
- Parainfluenza VIrus
- Covid19
- Human Herpesvirus 6
- HIV Infection
- Mumps
- Parvovirus B19
- Poxviruses
- Rotavirus
- Epstein-Barr Virus (EBV, Mononucleosis)
- Vaccinations
VI. Symptoms
- Non-pruritic papular rash accompanying Viral Infections
VII. Findings
- Symmetric rash, progressing over a 3-4 day course and persisting >10 days
- Onset on buttocks and thighs
- Develops on extensor arms including palms
- Extensor legs and foot soles may also be involved
- Ultimately involves face (esp. cheeks)
- Resolves over 2 to 8 weeks (rare recurrence)
-
Papules
- Diameter 5-10 mm
- Younger children have larger lesions than older children
- Color starts as dull red, becoming deep red and may appear purple
- Small Vesicles may develop
- Diameter 5-10 mm
- Associated findings
- Lymphadenopathy inguinal and axillary (resolves over weeks to months)
VIII. Differential Diagnosis
IX. Management
- Symptomatic management only
- May apply skin Emollients
- Short-term, low potency Topical Corticosteroids may be considered
X. References
- Snowden (2024) Papular Acrodermatitis, StatPearls
- Oakley (2015) Papular Acrodermatitis of childhood, DermNet