Papulous acrodermatitis in children is a viral skin disease characterized by acral erythematous papules, large superficial lymph nodes, and large liver and spleen. Some medical experts believe that this is a skin disease caused by hepatitis B virus infection through the skin mucosa or digestive tract mucosa, so remind this situation to check the liver function.
The onset age of patients with this disease is from 6 months to 15 years old, and most of them are children aged 2-6 years old. The incidence of adults is rare. Generally, the hair is good in spring and summer. Without obvious prodromal symptoms, it suddenly spreads in the extremities from the back of hands and feet to the upper limbs and buttocks, but the trunk is not affected. There are large flat, solid papules from needle tip to mung bean, dark red, purple red or light brown. When skin rash occurs, it can be accompanied by superficial lymph node enlargement of the whole body, especially in the neck, armpit and inguinal lymph nodes. It can also have reversible hepatosplenomegaly.
At the same time or 1-2 weeks after the eruption, there will be acute hepatitis B without jaundice, with positive surface antigen and elevated serum transaminase. The rash lasts for 20-40 days, showing mild desquamation and subsides. When the rash subsides, hepatitis reaches the extreme stage, but the patient is generally in good condition. A few patients may have low fever, fatigue and general malaise.
The disease is self limited, lasting for 2 weeks to 2 months, with good prognosis and no recurrence. Generally, symptomatic treatment should be given, but the accompanying hepatitis B should be actively treated. In case of itching, local calamine lotion and glucocorticoid topical preparations, such as hydrocortisone butyrate cream or mometasone furoate cream, can be applied externally. When the itching is serious, the antihistamine loratadine can be taken orally.
Hu Yaying, Institute of Dermatology, Jiangyan District, Taizhou City, Jiangsu Province
