Acropustulosis: Symptoms, Causes, and Treatment Options

Acropustulosis of Infancy (Infantile Acropustulosis)

Acropustulosis is a recurrent, self-limited pustular eruption on palms/soles of infants (2–12 months), often misdiagnosed as scabies or bacterial infection.

Clinical Features

Lesions: 2–10 mm sterile pustules on palms, soles, dorsal hands/feet.
Symptoms: Intense pruritus, irritability, sleep disturbance.
Course: Crops last 7–14 days; recur every 2–4 weeks; resolves by age 2–3 years.
No Systemic Signs: Afebrile, well-appearing.

Etiology

Unknown. Postulated: immune dysregulation, viral trigger (enterovirus), drug reaction, scabies hypersensitivity (even after treatment).
Not infectious (sterile pustules; cultures negative).

Differential Diagnosis

Treatment

Reassurance: Benign, self-resolving.
Symptomatic: Low-potency topical steroid (hydrocortisone 1–2.5%) + emollient for pruritus.
Antihistamines: Sedating (diphenhydramine) for sleep.
Dapsone: Rare, severe cases (monitor G6PD, CBC).
Antibiotics: Only if secondary infection proven.

Prognosis

Excellent. Complete resolution by age 3 typically. No scarring. No long-term sequelae.

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