Acropustulosis, Infant, Pustules, Teledermatology



  1. Gust, Peter
  2. Jacob, Sharon E.


ABSTRACT: Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a teledermatology case of multiple pustules presenting on the foot.


Article Content

The store-and-forward feature of teledermatology allows patient medical information (including history and visual data) obtained from one provider's location to be electronically transferred to a provider in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.




Chief complaint: presenting for diagnosis and recommended treatment options.


History of Present Illness

A 7-month-old female infant presents with multiple pustules on the lateral aspects of both feet including the plantar surface. These pustules started forming 6 days ago. Her prior treatment: none. Her primary symptoms: irritability. Prior biopsies: none.



Fully satisfactory.



There is one image provided with this consult. Scattered pustules are seen in various stages on the planter and lateral aspects of this infant's foot. Notably, the most superior lesion shows a fluid-tension line, and there is also macular hyperpigmentation overlying older crusted, deflated vesiculo-pustular lesions (see Figure 1).

Figure 1 - Click to enlarge in new windowFIGURE 1. Scattered pustules can be seen along the planter and lateral aspects of the foot. Healed pustules, closer toward the heel, can be seen sloughing off their dead epidermal layers revealing newly formed skin below.


Lesion A


The distribution, appearance, and history of the papules (seen in Figure 1) on the plantar and lateral aspects of this patient's foot are consistent with the diagnosis of acropustulosis of infancy (API).



Skin Care Recommendations

No treatment necessary due to the self-limited nature of this condition.


Medication recommendations: none at this time. Sparing use of topical midpotency steroids and antihistamines to control pruritus may be considered if condition progresses symptomatically.


Other treatment recommendations: none.



Type of Visit

Follow up with primary care provider in 2 weeks or if the patient becomes increasingly symptomatic with signs of secondary bacterial infection (e.g., redness, swelling, warmth). Refer to dermatology if no improvement in 6 weeks.



The etiology of API is relatively unknown. It has been hypothesized that, in some cases, the pustular eruptions occur subsequent to infection with scabies, but a clear cause-and-effect relationship with scabies has yet to be confirmed. A correlation has also been suggested between API and atopic dermatitis (Andreychik, 2014).


API is a disease that predominantly afflicts children less than 1 year old. These patients typically present to clinic with a distribution of pustules on their hands and feet in various stages of healing (Paloni, Berti, & Cutrone, 2013). Onset is noted by erythematous macules that eventually evolve into independent (less often coalesced) pustules and/or vesicles. Classically, the condition presents in bouts that last 3-14 days, often with recurrence in 2- to 4-week intervals. Most patients spontaneously remit. The severity (intensity and duration) of each exacerbation has been shown to decrease with each successive occurrence (Andreychik, 2014).


In most cases, treatment is unnecessary as this disease is considered a self-limited process. All current treatment options are directed at symptomatic management. Topical steroids may be used to control pruritus in severely symptomatic cases of API. Antihistamines and 1% pramoxine (topical anesthetic) have also been reportedly used for symptomatic relief (Andreychik, 2014).




Andreychik M. A. (2014). Acropustulosis of infancy. Retrieved from[Context Link]


Paloni G., Berti I., Cutrone M. (2013). Acropustulosis of infancy. Archives of Disease in Childhood. Fetal and Neonatal Edition, 98(4), F340. doi:10.1136/archdischild-2012-302685 [Context Link]


Roman M., Jacob S. E. (2015). Teledermatology: Virtual access to quality dermatology care and beyond. Journal of the Dermatology Nurses' Association, 6(6), 285-287. [Context Link]


1The standardized teledermatology reader report format is available for authors on the journal's Web site ( and on the submissions Web site online at [Context Link]