Pediatric acrodermatitis papularis. Acrodermatitis papular in childhood (Gianotti-Crosti syndrome) - Clinical guidelines Ailments with similar symptoms
Papular acrodermatitis or Gianotti-Crosti syndrome is a reaction to the introduction of a viral infection. The disease became known in 1955, and the infectious etiology of the disease was confirmed in 1970. The average age of those affected is 2 years, but cases of infection in adults are known. However, the disease does not require any special treatment, since the symptoms usually go away on their own after some time.
Reasons
Acrodermatitis papularis occurs in response to the reintroduction of viral particles into the body. Symptoms occur more often when infected with hepatitis B or Epstein-Barr, and the disease may develop due to infection with other viruses. At the first contact of the body with the virus, antibodies are produced, which, when the agent enters again, begin to attack the cells of its own body.
The disease most often occurs in winter or autumn, when viral activity is especially high.
Symptoms
Gianotti-Crosti syndrome includes several main symptoms: a papular rash with rare vesicular elements, lymphadenopathy and hepatosplenomegaly. Papules are pink or reddish, up to 5 mm in diameter, appear symmetrically on the face, extensor surfaces of the joints, skin of the extremities and buttocks. The skin of the body is rarely affected. Papules are painless and do not itch. Elements of the rash appear and spread within seven days, gradually disappearing over 2-8 weeks.
The appearance of the rash is accompanied by an enlargement of the peripheral lymph nodes, and, less commonly, of the liver and spleen. There may be an increase in body temperature and an increase in general weakness.
Diagnostics
Diagnosis is based on an assessment of the clinical picture and blood test data. Leukopenia or lymphocytosis is detected in the blood - nonspecific signs of viral infections. Specific tests are effective only when looking for hepatitis B; infection with this virus is usually ruled out first.
Treatment
Treatment of the disease is symptomatic and includes the use of antihistamines, antipyretics, and vitamin-mineral complexes. Rarely resort to the use of corticosteroid hormones; in its place, ointments with an antibacterial effect are prescribed.
To alleviate the condition, bed rest and drinking plenty of fluids are indicated.
Photo
Gianotti-Crosti syndrome
Infantile acrodermatitis papularis
Skin diseases in children
Skin diseases in children
Professor, Department of Dermatovenereology, St. Petersburg State Pediatric Medical Academy
Zverkova F. A.
Children's papular acrodermatitis (acrodermatitis papular of children; disease, or Crosti-Gianotti syndrome; eruptive reticuloendotheliosis of the extremities).
In 1955, Gianotti first described a disease that he observed in 3 children and called “acrodermatitis papular in children.” In 1957, Gianotti and Crosti described in detail the clinical picture and features of the course of this dermatosis based on joint observations of 11 children. Subsequently, both in pediatric and dermatological journals in different countries, reports of individual observations usually appeared under the name Gianotti-Crosti syndrome.
It is possible that this dermatosis occurs more often in children than is diagnosed. Mostly girls aged from 6 months to 15 years are affected.
The disease is characterized by a sudden, acute onset, sometimes a rise in temperature to 38-39 °C and the appearance of a monomorphic papular rash located symmetrically, mainly on the extensor surfaces of the extremities. Gradually, the rash can spread to the shoulder girdle, neck, forehead, ears, buttocks and abdomen, less often it appears on the face, scalp, back and chest. The mucous membranes are extremely rarely affected.
Typical papules range in size from 1 to 3 mm in diameter, are hemispherical or flat in shape, and have a stagnant red, copper-red or yellowish color. Elements of the rash are located on unchanged skin and, as a rule, do not tend to merge; only in some patients the papules merge into small polygonal plaques. During diascopy, the papules acquire a yellowish color. The affected skin resembles that of a leopard or giraffe. In some patients on the lower extremities, nodules are combined with petechiae; sometimes a positive Konchalovsky-Rumpel-Leede symptom is determined. Some children develop a rash on the body that resembles prickly heat, or pinpoint blisters appear on lenticular papules. After a few days, slight peeling begins in the center of the elements, gradually intensifying as the papules resolve. The latter last from several days to 1.5 months. After the rash disappears, no changes remain on the skin. There are no subjective sensations, only sometimes moderate itching may be noted.
At the onset of the disease, respiratory tract infections with mild fever, anorexia, and slight enlargement of the liver and spleen may be observed; sometimes a measles-like rash appears, followed by a rash characteristic of this dermatosis. One of the important signs is an increase in the inguinal, femoral, axillary, cervical, and less commonly, ulnar lymph nodes. They range in size from a pea grain to a bean, are painless on palpation, are of medium density, are not fused to the skin and underlying tissues, and the skin over them is not changed. Lymph nodes appear and disappear at the same time as the rash.
In peripheral blood, hypochromic anemia, eosinophilia, leukocytosis or leukopenia are detected.
According to our data, childhood papular acrodermatitis can occur in 3 variants:
- cutaneous form without liver damage;
- its combination with benign anicteric hepatitis;
- cutaneous form with severe liver damage and obvious jaundice.
Benign hepatitis ends in 4-6-8 weeks. In more severe cases, the manifestations of hepatitis with jaundice last longer and occur with more pronounced general symptoms.
Etiology and pathogenesis.
There is information about the connection between childhood papular acrodermatitis and anti-smallpox, anti-myelitis vaccinations, focal infection, including tonsillitis. They indicate the possibility of a viral origin of this disease, as evidenced by the combination with infection caused by hepatitis, Eptain-Barr, Coxsackie, and parainfluenza viruses. In addition, seasonal fluctuations in the incidence of this dermatosis, characteristic of viral diseases, have been established. There is also a direct connection between childhood papular acrodermatitis and hepatitis B.
In a number of cases, Australian antigen was detected in the blood serum of patients, despite the fact that liver function tests were normal or at the upper limit of normal. We observed such a picture in a patient aged 4 months. With papular acrodermatitis of children, accompanied by hepatitis B, skin rashes first appear, and after 10-15 days hepatitis appears, often persisting for a year. Sometimes, this hepatitis can sometimes take a chronic course and even cause further post-necrotic cirrhosis in adults.
Treatment
Treatment must be differentiated. For mild forms of the disease, calcium supplements, antihistamines, and vitamins C and B are prescribed orally in age-appropriate dosages. Indifferent shaken suspensions are used externally.
It is necessary to hospitalize sick children with functional studies of the liver, and if its pathology is detected, patients must be transferred to the infectious diseases department.
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Syn.: Gianotti-Crosti syndrome.
The disease develops in children mainly of young age, is acute, and regresses without a trace within 1 - 2 months.
It is characterized by a symmetrical rash of lenticular papules on the limbs, buttocks, face, accompanied by polyadenopathy. The papules are pinkish or red with a bluish tint, and sometimes have a hemorrhagic appearance.
This may be accompanied by hepatitis of varying severity. The disease is associated with a viral infection.
Pathohistology
Histological changes in the lesions are nonspecific.
In the upper dermis- inflammatory infiltrate, involving the papillae and often penetrating into the epidermis, where spongiosis and parakeratosis are observed. Sometimes small extravasates of red blood cells are found in these places.
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Almost 60 years ago, the disease was described by the doctor Gianotti, who discovered in the patient enlarged lymph nodes, manifestations of hepatitis (inflammation of the liver) and a red rash in the form of papules, elements that rise slightly above the surface of the skin, in the face, limbs and buttocks.
At first, the doctor suggested that the disease was directly related to the penetration of the virus into the human body. The disease began to be called papular acrodermatitis of children, that is, one of the inflammatory skin diseases. At the end of the 50s, the disease also became known as Gianotti-Crosti syndrome.
Causes of the disease
A few years later, the infectious nature of dermatitis was confirmed and at that time it was believed that the hepatitis B virus was to blame, and acrodermatitis papularis in children was a specific sign of hepatitis B itself. Thus, treatment of dermatitis in children was carried out in conjunction with treatment of the underlying disease.
A little later, a similar disease was discovered, but without the involvement of the hepatitis B virus, but Gianotti was sure that the new disease differed from acrodermatitis papularis in children in its symptoms. However, these two pathological conditions were eventually combined into Gianotti-Crosti syndrome.
Who has Gianotti-Crosti syndrome?
No genetic predisposition to the disease has been identified at this time. It was noted that males were slightly more affected by the disease, and the average age of onset was 2 years. In total, children from 6 months to 14 years are mostly affected.
Acrodermatitis most often occurred during the autumn and winter months, while cases of the disease in adults are not uncommon, and most of the sick adults suffered from hepatitis B.
In addition to the hepatitis B virus, one of the herpes viruses (Epstein-Barr virus, which becomes the cause) was identified in North America.
Symptoms of the disease
The disease begins with the appearance of a rash on the face, legs, arms and buttocks. The rash is often accompanied by itching. For the most part, there are no symptoms of a viral disease, but when visiting a doctor, enlarged lymph nodes, increased body temperature, mouth ulcers, inflammation of the pharynx, and enlarged liver and spleen are often detected. We present to your attention photo of dermatitis in children.
Nature of the rash
Upon examination, the elements of the rash appear as small plaques, or papules, rising above the surface of the skin, and all the elements are identical in nature, that is, there are no blisters or ulcers. The torso never becomes covered with such a rash and remains clean throughout the entire illness. The virus can only cause a rash on the face.
Papules usually range in size from 1 to 5 mm, they are dense to the touch, and have a dome shape. Elements of the rash can appear in places of injury and damage, which makes them similar to psoriatic papules. Often the papules merge in the area of the knees and elbows, forming large foci of dermatitis.
Most often the plaques are red, but pink and purple specimens may occur. It is not so easy to notice such elements.
The spread of the rash can continue for a week, gradually affecting more and more new areas of the skin. The rash disappears within 2-8 weeks.
What methods are there for diagnosing Gianotti-Crosti syndrome?
Laboratory tests do not reveal specific indicators in the absence of the virus. If the disease is still caused by a virus, it is detected using polymerase chain reaction, serological techniques, and immunofluorescence.
Diseases that can lead to the development of Gianotti-Crosti syndrome
This disease can occur against the background of the following infections:
- Rotavirus and cytomegalovirus infections;
- RS virus infection and parainfluenza;
- and enterovirus infection;
- Herpes virus infection caused by all types of virus.
In addition to these infections, there have been reports that acrodermatitis papularis in children occurs after vaccinations against measles, whooping cough, tetanus, and polio, that is, after basic childhood vaccinations.
Recent scientific publications have reported the appearance of rashes when a child is infected with pathogens such as mycoplasma, group A beta-hemolytic streptococcus, and meningococcus.
Stages of development of Gianotti-Crosti syndrome
When the virus enters the child’s body, it spreads through the blood into the skin. After this, an immune response develops, which triggers inflammation, which is manifested by a rash. This immune reaction is very similar to the reaction that occurs in allergies.
How can you reliably recognize Gianotti-Crosti syndrome?
To diagnose the disease, the Chuh practitioner proposed introducing certain criteria, which are divided into positive and negative clinical manifestations. Positive symptoms:
- dome-shaped identical papules of red or bright pink color from 1 to 9-10 mm in diameter;
- specific affected areas: buttocks, extensor surfaces of the legs and arms, forearms, face;
- the rash is symmetrical;
- the duration of the rash is at least 10 days.
Negative symptoms, that is, symptoms that can refute the diagnosis of acrodermatitis papularis in children:
- the rash also spreads to the body;
- peeling of rash elements.
What diseases should be distinguished from acrodermatitis papularis in children?
Gianotti-Crosti syndrome is easily confused with other skin diseases, since awareness of this pathology is insufficient.
In the presence of purple elements of the rash, the development of thrombocytopenic purpura, or Henoch-Schönlein disease (blood disease), septicemia (the presence of bacteria in the blood), and lichenoid parapsoriasis cannot be ruled out. If there are enlarged
Symptoms of psoriasis are inflamed, scaly, red patches accompanied by severe itching. Such spots (plaques) are most often located on the scalp, knees and elbow joints, in the lower back and in skin folds. Nails are affected in about a quarter of patients. Depending on the seasonality of relapses (exacerbation of the disease), three types of psoriasis are distinguished: winter, summer, indeterminate. The most common winter type of psoriasis. During the period of exacerbation, manifestations of psoriasis on the hands, knees, head, as well as in the lower back and in places of skin folds appear in the form of reddish plaques. Their sizes vary from the head of a pin to large areas the size of a palm or more. The rash is usually accompanied by peeling and painful itching. During the peeling process, the surface scales easily peel off, leaving denser scales located in the depths (hence the second name for psoriasis - lichen planus). Sometimes cracks and suppuration occur in the area of the affected skin. Progressive psoriasis is characterized by the so-called Koebner phenomenon: the development of psoriatic plaques in places of injury or scratches of the skin. Nails are affected in about a quarter of patients. In this case, pinpoint depressions and spotting of the nail plates appear. In addition, nails may thicken and crumble. In the summer, under the influence of sunlight, in patients with the winter form of psoriasis, the symptoms weaken and sometimes even disappear altogether. Patients with summer psoriasis, on the other hand, are advised to avoid exposure to the sun, as it worsens the disease.
