Gianotti-crosti syndrome

The Gianotti-Crosti syndrome is a characteristic response of the skin to viral infection in which there is a papular rash which lasts for several weeks. Other names sometimes used for this skin condition include papulovesicular acrodermatitis of childhood, papular acrodermatitis of childhood and acrodermatitis papulosa infantum.

The specific viruses causing Gianotti-Crosti syndrome include:

• Hepatitis B infection
• Epstein Barr virus (the cause of glandular fever)
• Enterovirus infections
• Echo viruses
• Respiratory syncytial virus

Who is affected?

Gianotti-Crosti syndrome mainly affects children between the ages of 6 months and 12 years. A clustering of cases is often observed. A preceding upper respiratory infection is common.

Clinical features

Over the course of 3 or 4 days a profuse eruption of dull red spots develops first on the thighs and buttocks, then on the outer aspects of the arms, and finally on the face. The rash is often asymmetrical.

The individual spots are 5-10 mm in diameter and are a deep red colour. Later they often look purple, especially on the legs, due to leakage of blood from the capillaries. They may develop fluid-filled blisters.

Itch is uncommon, particularly if hepatitis B is the cause.

Gianotti-Crosti syndrome

Hepatitis B	Epstein-Barr virus infection	Unknown cause

The patient may feel quite well or have a mild temperature. Mildly enlarged lymph nodes in the armpits and groins may persist for months.

There is seldom any jaundice even when the rash is caused by hepatitis B but there are may be abnormal liver function tests and an enlarged liver.

Investigations

Blood tests may be done for liver function and to check for hepatitis B, glandular fever and other viruses.

What is the outlook for Gianotti-Crosti syndrome

The rash fades in 2-8 weeks with mild scaling.

If hepatitis B is present, the liver takes between 6 months and 4 years to recover fully. Sometimes there is persistent hepatitis and long term viral carriage.

Recurrence of the Gianotti-Crosti syndrome is unlikely but has been reported.

What treatment is available for the Gianotti-Crosti syndrome?

There is no specific treatment. A mild topical steroid cream may be prescribed for itch.