Gianotti-Crosti Syndrome in Children

As I have said before (and I’m sure others of you have nodded along in agreement), “I hate rashes.” My disdain for rashes, however, only seems to ensure that every shift presents me with another opportunity to find clever and reassuring ways to say “viral exanthem.” Clearly, not all rashes are related to viral infections (ex, DRESS, RMSF, HSP, Diaper Dermatitis) and we have previously discussed an approach to pediatric rashes. That being said, there are too numerous to count viruses and many, if not all, can cause some degree of rash (ex, Measles, Varicella, Eczema Herpeticum, Hand Foot Mouth Disease). So “viral exanthem” may be correct, but before you use it as your default rash diagnosis, consider another entity that is fun to say (and will have parents testing their internet search engines all day!) – Gianotti-Crosti Syndrome:

Gianotti-Crosti Syndrome: Basics

• Also known as Papular Acrodermatitis
• Often occurs in spring and summer months
• Heals without scarring (can cause some hypopigmentation initially)
• May last 2-4 weeks (or longer)
• Most commonly occurs between ages 1 and 6 years of age.
  • Can occur in adolescents and even adults.

• Associated with viral infections including:
  • Hepatitis B, Hepatitis A, Hepatitis C
  • Epstein-Barr
  • Parvovirus B19
  • CMV
  • Influenza, Parainfluenza, RSV, Adenovirus, Echovirus
  • Coxsackieviruses
  • Molluscum contagiosum virus
  • Rubella virus, Mumps virus

• Other associations:
  • More common in patients with history of atopy or atopic dermatitis.
  • Has been known to occur following immunizations.
    • Not an allergic reaction.
    • Good to anticipate to avoid any additional cause of vaccine hesitancy.

• Pathology:
  • Exact pathology is not known, but evidence of:
    • Associated IgE elevations
    • Delayed Type 4 hypersensitivity reaction
    • Related to immunologic response rather than response to the primary infection

Gianotti-Crosti Syndrome: Presentations

• Prior to rash developing:
  • Viral syndrome symptoms
  • History of recent immunization

• Rash characteristics:
  • Acute Onset
  • Papular or Papulo–vesicular eruptions
    • 1 to 5 mm diameter lesions (may become confluent though)
    • Monomorphous
    • Skin-colored, salmon colored, red, or red-brown
    • Flat-topped
    • Firm
    • Without scale
  • Located predominantly on extensor surfaces of extremities, buttocks, and face
    • Usually spares antecubital fossae and popliteal fossae
    • Usually spares palms, soles, scalp, nails, and mucous membranes (unlike Hand-Foot-Mouth Disease)
  • Symmetrically distributed
  • Mildly to moderately pruritic.
  • Not tender.

• Other findings:
  • Cervical, axillary, and/or inguinal lymphadenopathy
  • Hepatomegaly and splenomegaly have been found (again, Hepatitis, CMV, and EBV can cause lots of problems)

Gianotti-Crosti Syndrome: Treatment

• Self-limited and benign condition.
• The rash is not contagious (the viral illness that started it certainly may be).
• Symptomatic management:
  • Topical emollients
  • Topical antipruritics
  • Topical corticosteroids (no specific research supporting this… but… rashes love steroids… right?)

Moral of the Morsel

• “Viral Exanthem” sounds smart… but “Gianotti-Crosti Syndrome” sounds serious! Sure, you may not be wrong calling it a viral exanthem, but you could be more right!
• Become comfortable with what makes you uncomfortable. Rashes will always find their way to your emergency department!

References:

Daniel SS, Peterman C, Awasthi S. Updates on postinfectious skin rashes in pediatric dermatology. Curr Opin Pediatr. 2024 Aug 1;36(4):431-435. doi: 10.1097/MOP.0000000000001376. Epub 2024 Jun 5. PMID: 38957128.

Leung AKC, Sergi CM, Lam JM, Leong KF. Gianotti-Crosti syndrome (papular acrodermatitis of childhood) in the era of a viral recrudescence and vaccine opposition. World J Pediatr. 2019 Dec;15(6):521-527. doi: 10.1007/s12519-019-00269-9. Epub 2019 May 27. PMID: 31134587.

Chuh A, Zawar V, Lee A, Sciallis G. Is Gianotti-Crosti Syndrome Associated with Atopy? A Case-Control Study and a Postulation on the Intrinsic Host Factors in Gianotti-Crosti Syndrome. Pediatr Dermatol. 2016 Sep;33(5):488-92. doi: 10.1111/pde.12886. Epub 2016 Jun 24. PMID: 27339179.