A 5-year-old girl presented with sudden onset, numerous,
mildly itchy, non-scaly elevated lesions on face, legs and
arms (Fig. 1-3) for a duration of 3-4 days,
preceded by an episode of fever and cough. There was no
family history or intake of drug. Examination, revealed
numerous dome-shaped and flat-topped red-brown papules and
papulo-vesicles involving face, extensor aspects of both
arms and lower legs. Some of the vesicles spontaneously
ruptured while some ruptured in response to itching. Trunk,
palm, soles and mucosa were spared. A diagnosis of
Gianotti-Crosti syndrome was made.
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Fig. 1 Papules and
papulovesicles over face.
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Fig. 2 Papules and
papulovesicles involving arm.
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Fig. 3 Symmetrical
distribution of papulovesicles on lower extremities.
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Gianotti-Crosti syndrome or papuloacrodermatitis of childhood is a common, self-limiting
dermatosis which affects children between 6 mo-12 y of age
with no sexual predilection and is more common in early
summer. Exact pathogenesis is not known. It is associated
with viral and bacterial infections and some vaccines. Viral
causes include Hepatitis B virus, Epstein barr virus (EBV),
respiratory syncytial virus, enterovirus etc. with
EBV being the most common cause. Mycoplasma pneumoniae
and Group A beta hemolytic streptococci are the bacterial
causes. It can also occur following DPT, BCG or HepB
vaccination. It is usually preceded by a prodrome of fever
and upper respiratory tract symptoms. The disease is
self-limiting and the lesions usually resolve in 3-4 weeks
without any sequelae. The close differentials include
scabies, papular urticaria and prurigo simplex; none of
which is preceded by a prodrome. In scabies, nocturnal
itching and a positive family history is noticeable. Papular
urticaria and prurigo simplex are entities characterized by
chronic course with relapses and remissions.