Clinical Challenge: Red, Bumpy Rash on a Child

Gianotti-Crosti syndrome, also known as papular acrodermatitis of childhood, was first described in 1955. It is a rare and benign skin condition that is typically seen in those between the ages of 1 and 4 and presents following viral infections,...

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Gianotti-Crosti syndrome, also known as papular acrodermatitis of childhood, was first described in 1955. It is a rare and benign skin condition that is typically seen in those between the ages of 1 and 4 and presents following viral infections, especially in the spring and summer months.¹

While most commonly seen in conjunction with hepatitis B and Epstein-Barr viral infections, Gianotti-Crosti syndrome has been associated with many other viruses, such as poxvirus, cytomegalovirus, human immunodeficiency virus, rotavirus, echovirus, parvovirus B19, respiratory syncytial virus, parainfluenza virus, adenovirus, hepatitis C, and hepatitis A.^1-3

Gianotti-Crosti syndrome has also been identified following vaccinations, including after the influenza, Tdap, polio, measles, Japanese encephalitis, hepatitis B, and bacillus Calmette-Guérin vaccines.¹ A history of atopy is also a risk factor for developing Gianotti-Crosti syndrome.^1,2

Patients affected by Gianotti-Crosti present with symmetric, papulovesicular eruptions on the face, buttocks, extensor surfaces of the limbs, and acral surfaces. The mucous membranes and flexor surfaces are usually spared. The papules are typically discrete, pink and flat-topped, and may be mildly pruritic.² Extra-integumentary symptoms in these patients may include generalized lymphadenopathy, fever, pharyngitis, hepatosplenomegaly, and elevated liver function test results. Lesions typically last 2-4 weeks; however, they may continue to appear for up to 2 to 3 months in some cases.¹

Differential diagnosis includes dermatitis, erythema multiforme, Langerhans cell histiocytosis, or other viral exanthems. The diagnosis of Gianotti-Crosti syndrome is usually based on clinical findings. Skin biopsies are not necessary and are typically nonspecific, showing epidermal spongiosis, capillary swelling, mononuclear infiltrates, and possible formation of a microabscess.^1-3

A strong consideration for diagnosis of Gianotti-Crosti syndrome should be for patients with a symmetric, papular rash lasting longer than 10 days and that is present in the aforementioned areas. Associated symptoms, including lymphadenopathy and hepatosplenomegaly, should also be indicative of this condition.^1-3

Gianotti-Crosti syndrome is a self-limiting disorder; however, if the rash is particularly pruritic, patients may achieve symptomatic relief with antihistamines, emollients, or topical steroids. Attention should also be paid to treating any underlying viral infections that might have preceded the presentation of the rash.

The parent of this patient was educated on the child’s condition and was given instructions to return to clinic if no improvement was seen in 6 weeks.

Cooper Tye, BS, is a medical student at the University of Texas Health in San Antonio. Cynthia Trickett, PA-C, is a practicing resident at North Dallas Dermatology Associated in Dallas, Texas. Alyssa Spiegel, PA-C, is a practicing resident at Mindful Dermatology in Dallas, Texas. Jennifer Cather, MD, is the practicing physician at Mindful Dermatology in Dallas, Texas.

References

1. Snowden J, Rice AS, O’Shea NE. Acrodermatitis popular. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020.

2. Baleviciené G, Maciuleviciené R, Schwartz RA. Papular acrodermatitis of childhood: the Gianotti-Crosti syndrome. Cutis. 2001;67(4):291-294.

3. Rubenstein D, Esterly NB, Fretzin D. The Gianotti-Crosti syndrome. Pediatrics. 1978;61(3):433-436.