A 7-year-old girl presents with an itchy rash that has been progressing in severity over the past several days. She is afebrile and denies a sore throat. Treatment with oral acyclovir and topical steroids was started elsewhere 2 days ago. Examination reveals multiple papules, quasi-vesicles, and occasional scaling plaques primarily on her arms but also involving her abdomen and face.
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Gianotti-Crosti syndrome (GCS), also known as papular acrodermatitis, is a self-limited eruption seen primarily in children. The rash appears acutely and typically involves the face, buttocks, and extensor surface of the extremities. The palms and soles of the feet are spared.1 Lesions are symmetric and begin as reddish to pink papules that may become edematous or evolve into scaling plaques. Pruritus is variable, and the condition may persist for several weeks.
An immunologic response to a viral infection may play a role in causality.2,3 GCS has been linked to a number of viruses, including Epstein-Barr and hepatitis B. The condition also has been associated with recent immunizations. Diagnosis is usually made clinically, and biopsy findings are nonspecific.4Treatment is supportive. Should the child manifest jaundice, lymphadenopathy, or hepatosplenomegaly, additional work-up is prudent.
Lauren Ax, MSPAS, PA-C, is a physician assistant on staff at the DermDox Center for Dermatology in Hazleton, Pennsylvania, and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.
1. Kwon NH, Kim JE, Cho BK, Park HJ. Gianotti-Crosti syndrome following novel influenza A (H1N1) vaccination. Ann Dermatol. 2011;23(4):554–555.
2. Snowden J, Badri T. Acrodermatitis Papular (Gianotti Crosti Syndrome). StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019.
3. Brandt O, Abeck D, Gianotti R, Burgdorf W. Gianotti-Crosti syndrome. J Am Acad Dermatol. 2006;54(1):136–145.
4. Liaw FY, Huang CF, Wu LW, Chiang CP. Acral papular rash in a 2-year-old boy. J Fam Pract. 2012;61(3):157-159.