Advertisement

World Journal of Pediatrics

, Volume 15, Issue 6, pp 521–527 | Cite as

Gianotti–Crosti syndrome (papular acrodermatitis of childhood) in the era of a viral recrudescence and vaccine opposition

  • Alexander K. C. LeungEmail author
  • Consolato Maria Sergi
  • Joseph M. Lam
  • Kin Fon Leong
Review Article
  • 98 Downloads

Abstract

Background

Gianotti–Crosti syndrome is characterized by an acute onset of a papular or papulovesicular eruption with a symmetrical distribution.

Data sources

A PubMed search was conducted using Clinical Queries with the key terms “Gianotti-Crosti syndrome” OR “papular acrodermatitis”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. This paper is based on, but not limited to, the search results.

Results

The eruption of Gianotti–Crosti syndrome is found predominantly on the cheeks, extensor surfaces of the extremities, and buttocks. There is a sparing of antecubital and popliteal fossae as well as palms, soles, and mucosal surfaces. Although often asymptomatic, the lesions may be mildly to moderately pruritic. Gianotti–Crosti syndrome is most common in children between 1 and 6 years of age. The Epstein–Barr virus and the hepatitis B virus are the most common pathogens associated with Gianotti–Crosti syndrome. No treatment for Gianotti–Crosti syndrome is necessary because it is self-limited. In an era of vaccine hesitancy and refusal, Gianotti–Crosti syndrome may be important to mention to parents, because it can occur and trigger alarmism.

Conclusions

Gianotti–Crosti syndrome is mainly a disease of early childhood, characterized by an acute onset of a papular or papulovesicular eruption with a symmetrical distribution. With the advent of more universal vaccination against hepatitis B virus, Epstein–Barr virus has become the most common etiologic agent of Gianotti–Crosti syndrome. Few cases of post-vaccination Gianotti–Crosti syndrome have been reported. Currently, the emphasis should be placed on its self-limiting attribution.

Keywords

Epstein–Barr virus Hepatitis B virus Papular acrodermatitis Papular symmetrical eruption 

Notes

Author contributions

AKCL wrote the first draft of the manuscript, as well as a statement of whether an honorarium, grant, or other form of payment was given to anyone to produce the manuscript. CMS, JML, and KFL contributed to drafting and revising the manuscript. The authors have seen and approved the final version submitted for publication and take full responsibility for the manuscript.

Funding

There is no honorarium, Grant, or other form of payment given to any of the author/coauthor.

Compliance with ethical standards

Ethical approval

Not applicable.

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

References

  1. 1.
    Leung AK. Gianotti-Crosti syndrome. In: Leung AK, editors. Common problems in ambulatory pediatrics, vol. 1. New York: Nova Science Publishers Inc.; 2011. p. 375–8. ISBN: 978-1-62100-358-8.Google Scholar
  2. 2.
    Dikici B, Uzun H, Konca C, Kocamaz H, Yel S. A case of Gianotti Crosti syndrome with HBV infection. Adv Med Sci. 2008;53:338–40.PubMedGoogle Scholar
  3. 3.
    Fastenberg M, Morrell DS. Acral papules: Gianotti-Crosti syndrome. Pediatr Ann. 2007;36:800–4.PubMedGoogle Scholar
  4. 4.
    Karakaş M, Durdu M, Tuncer I, Cevlik F. Gianotti-Crosti syndrome in a child following hepatitis B virus vaccination. J Dermatol. 2007;34:117–20.PubMedGoogle Scholar
  5. 5.
    Chuh AA. Gianotti-Crosti syndrome (papular acrodermatitis). In: Post TW, editor. Waltham: UpToDate; 2019 (Accessed 10 February 2019).Google Scholar
  6. 6.
    Gianotti F. Report on a special case of toxic infection characterized by a desquamative erythemato-infiltrative eruption with lenticular foci and a selective localization at the extremities. Soc Ital Dermatol Sifilogr Sezioni Interprov Soc Ital Dermatol Sifilogr. 1955;96:678–97.PubMedGoogle Scholar
  7. 7.
    Crosti A, Gianotti F. Eruptive dermatosis of probable viral origin situated on the acra. Dermatologica. 1957;115:671–7.PubMedGoogle Scholar
  8. 8.
    Brandt O, Abeck D, Gianotti R, Burgdorf W. Gianotti-Crosti syndrome. J Am Acad Dermatol. 2006;54:136–45.PubMedGoogle Scholar
  9. 9.
    Marcassi AP, Piazza CAD, Seize MBMP, Cestari SDCP. Atypical Gianotti-Crosti syndrome. An Bras Dermatol. 2018;93:265–7.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Yoshida M, Tsuda N, Morihata T, Sugino H, Iizuka T. Five patients with localized facial eruptions associated with Gianotti-Crosti syndrome caused by primary Epstein–Barr virus infection. J Pediatr. 2004;145:843–4.PubMedGoogle Scholar
  11. 11.
    Al-Dhaheri HS, Al-Kaabi A, Kara-Hamo Y, Al-Kaabi A, Al-Kaabi S, Al-Tatari H. Unusual presentation of Gianotti-Crosti syndrome due to Epstein–Barr virus infection. Case Rep Dermatol Med. 2016;2016:1017524.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Ricci G, Patrizi A, Neri I, Specchia F, Tosti G, Masi M. Gianotti-Crosti syndrome and allergic background. Acta Derm Venereol. 2003;83:202–5.PubMedGoogle Scholar
  13. 13.
    Brewer AC, Michaels JD, Hobohm D, DiCaudo DJ, Nguyen X. Gianotti-Crosti syndrome in a postpartum adult. Int J Dermatol. 2015;54:84–5.PubMedGoogle Scholar
  14. 14.
    Cocciolone R, Morey A, Panasiuk P, Whitfeld MJ. Atypical Gianotti-Crosti syndrome in two HIV and hepatitis B co-infected adults. Australas J Dermatol. 2011;52:32–6.PubMedGoogle Scholar
  15. 15.
    Pedreira RL, Leal JM, Silvestre KJ, Lisboa AP, Gripp AC. Gianotti-Crosti syndrome: a case report of a teenager. An Bras. Dermatol. 2016;91(5 suppl 1):163–5.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Stojkovic-Filipovic J, Skiljevic D, Brasanac D, Medenica L. Gianotti-Crosti syndrome associated with Ebstein–Barr virus and parvovirus B-19 coinfection in a male adult: case report and review of the literature. G Ital Dermatol Venereol. 2016;151:106–11.PubMedGoogle Scholar
  17. 17.
    Snowden J, Badri T. Acrodermatitis, Papular (Gianotti Crosti syndrome). StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2018 Jan–2017 Oct 11.Google Scholar
  18. 18.
    Tagawa C, Speakman M. Photo quiz: papular rash in a child after a fever: Gianotti-Crosti syndrome. Am Fam Physician. 2013;87:59–60.PubMedGoogle Scholar
  19. 19.
    Llanora GV, Tay CM, van Bever HP. Gianotti-Crosti syndrome: case report of a pruritic acral exanthema in a child. Asia Pac Allergy. 2012;2:223–6.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Ishimaru Y, Ishimaru H, Toda G, Baba K, Mayumi M. An epidemic of infantile papular acrodermatitis (Gianotti’s disease) in Japan associated with hepatitis-B surface antigen subtype ayw. Lancet. 1976;1:707–9.PubMedGoogle Scholar
  21. 21.
    Kanzaki S, Kanda S, Terada K, Nohno S, Kumano K, Narahara K, et al. Detection of hepatitis B surface antigen subtype adr in an epidemic of papular acrodermatitis of childhood (Gianotti’s disease). Acta Med Okayama. 1981;35:407–10.PubMedGoogle Scholar
  22. 22.
    Toda G, Ishimaru Y, Mayumi M, Oda T. Infantile papular acrodermatitis (Gianotti’s disease) and intrafamilial occurrence of acute hepatitis B with jaundice: age dependency of clinical manifestations of hepatitis B virus infection. J Infect Dis. 1978;138:211–6.PubMedGoogle Scholar
  23. 23.
    Baldari U, Monti A, Righini MG. An epidemic of infantile papular acrodermatitis (Gianotti-Crosti syndrome) due to Epstein–Barr virus. Dermatology. 1994;188:203–4.PubMedGoogle Scholar
  24. 24.
    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;33:488–92.PubMedGoogle Scholar
  25. 25.
    Chuh A, Zawar V, Sciallis GF, Kempf W, Lee A. Pityriasis rosea, Gianotti-Crosti syndrome, asymmetric periflexural exanthem, papular-purpuric gloves and socks syndrome, eruptive pseudoangiomatosis, and eruptive hypomelanosis: do their epidemiological data substantiate infectious etiologies? Infect Dis Rep. 2016;8:6418.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Sears W, Hodge B, Jones B, Thompson M, Vidwan N. Visual diagnosis: 12-month-old boy with persistent rash and lymphadenopathy. Pediatr Rev. 2014;35:452–5.PubMedGoogle Scholar
  27. 27.
    Drago F, Javor S, Ciccarese G, Parodi A. Gianotti-Crosti syndrome as presenting sign of cytomegalovirus infection: a case report and a critical appraisal of its possible cytomegalovirus etiology. J Clin Virol. 2016;78:120–2.PubMedGoogle Scholar
  28. 28.
    Carrascosa JM, Just M, Ribera M, Ferrándiz C. Papular acrodermatitis of childhood related to poxvirus and parvovirus B19 infection. Cutis. 1998;61:265–7.PubMedGoogle Scholar
  29. 29.
    Babu TA, Arivazhahan A. Gianotti-Crosti syndrome following immunization in an 18 months old child. Indian Dermatol Online J. 2015;6:413–5.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Robl Imoto R, Uber M, de Carvalho VO. Papular crusted rash in a child after immunisation. Arch Dis Child. 2018.  https://doi.org/10.1136/archdischild-2018-314922.CrossRefGoogle Scholar
  31. 31.
    Kroeskop A, Lewis AB, Barril FA, Baribault KE. Gianotti-Crosti syndrome after H1N1-influenza vaccine. Pediatr Dermatol. 2011;28:595–6.PubMedGoogle Scholar
  32. 32.
    Kwon NH, Kim JE, Cho BK, Park HJ. Gianotti-Crosti syndrome following novel influenza A (H1N1) vaccination. Ann Dermatol. 2011;23:554–5.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Lam JM. Atypical Gianotti-Crosti syndrome following administration of the AS03-adjuvanted H1N1 vaccine. J Am Acad Dermatol. 2011;65:e127–8.PubMedGoogle Scholar
  34. 34.
    May J, Pollack R. Giannoti-Crosti syndrome associated with type A influenza. Pediatr Dermatol. 2011;28:733–5.PubMedGoogle Scholar
  35. 35.
    Retrouvey M, Koch LH, Williams JV. Gianotti-Crosti syndrome after childhood vaccination. Pediatr Dermatol. 2012;29:666–8.PubMedGoogle Scholar
  36. 36.
    Sigmon JR, Venkatesh S, Lesher JL. Gianotti-Crosti syndrome associated with hepatitis A and influenza vaccination. J Drugs Dermatol. 2012;11:260–1.PubMedGoogle Scholar
  37. 37.
    Zawar V, Chuh A. A case-control study on the association of pulse oral poliomyelitis vaccination and Gianotti-Crosti syndrome. Int J Dermatol. 2017;56:75–9.PubMedGoogle Scholar
  38. 38.
    Baldari U, Cattonar P, Nobile C, Celli B, Righini MG, Trevisan G. Infantile acrodermatitis of Gianotti-Crosti and Lyme borreliosis. Acta Derm Venereol. 1996;76:242–3.PubMedGoogle Scholar
  39. 39.
    Cambiaghi S, Scarabelli G, Pistritto G, Gelmetti C. Gianotti-Crosti syndrome in an adult after influenza virus vaccination. Dermatology. 1995;191:340–1.PubMedGoogle Scholar
  40. 40.
    Caltabiano R, Vecchio GM, De Pasquale R, Loreto C, Leonardi R, Vasquez E. Human β-defensin 4 expression in Gianotti-Crosti. Acta Dermatovenerol Croat. 2013;21:43–7.PubMedGoogle Scholar
  41. 41.
    Chuh A. Association of hyperimmunoglobulin E syndrome and Gianotti-Crosti syndrome. Pediatr Infect Dis J. 2005;24:942.PubMedGoogle Scholar
  42. 42.
    Molvi MA, Sharma YK, Dash K, Patwekar M, Kohli S, Panicker NK. Pediatric idiopathic hypereosinophilic syndrome with Gianotti-Crosti syndrome: a novel presentation. Int J Dermatol. 2015;54:1416–9.PubMedGoogle Scholar
  43. 43.
    Wells L, Mahil S. Rash on extensor surfaces of a child. BMJ. 2018;360:j5547.PubMedGoogle Scholar
  44. 44.
    Xia Y, Davies BE, Gunning S. Pruritic acral rash in a child Gianotti-Crosti syndrome. Am Fam Physician. 2008;78:103–5.PubMedGoogle Scholar
  45. 45.
    Liaw FY, Huang CF, Wu LW, Chiang CP. Acral papular rash in a 2-year-old boy. J Fam Pract. 2012;61:157–9.PubMedGoogle Scholar
  46. 46.
    Wu CY, Huang WH. Question: can you identify this condition? Gianotti-Crosti syndrome. Can Fam Physician. 2009;55(712):716.PubMedCentralGoogle Scholar
  47. 47.
    Sarma N, Sarkar UK, Das MK, Das S. Hemorrhagic Gianotti-Crosti syndrome in a one and half month old infant: an extremely unusual presentation. Indian J Dermatol. 2013;58:65–7.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Gibbs S, Burrows N. Gianotti-Crosti syndrome in two unrelated adults. Clin Exp Dermatol. 2000;25:594–6.PubMedGoogle Scholar
  49. 49.
    Rosenblatt AE, Stein SL. A 22-month-old girl with lesions on the face and extremities. Pediatr Ann. 2013;42:18–20.PubMedGoogle Scholar
  50. 50.
    Linke M, Géraud C, Schneider SW, Goerdt S, Utikal J. Acute disseminated erythematous papulovesicular skin lesions in a 7-year-old child: a quiz. Diagnosis: vesicular Gianotti-Crosti syndrome. Acta Derm Venereol. 2011;91:491-4.Google Scholar
  51. 51.
    Feldmann R, Wruhs M, Loader D, Steiner A. Papular-purpuric gloves and socks syndrome. J Dtsch Dermatol Ges. 2015;13:1286–8.PubMedGoogle Scholar
  52. 52.
    Hoy NY, Leung AK, Metelitsa AI, Adams S. New concepts in median nail dystrophy, onychomycosis, and hand, foot, and mouth disease nail pathology. ISRN Dermatol. 2012;2012:680163.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Leung AK, Ng J. Generalized lichen nitidus in identical twins. Case Rep Dermat Med. 2012;2012:982084.Google Scholar
  54. 54.
    Leung AK, Barankin B. Unilateral laterothoracic exanthem. J Pediatr. 2015;167:775.PubMedGoogle Scholar
  55. 55.
    Mathes EF, Oza V, Frieden IJ, Cordoro KM, Yagi S, Howard R, et al. "Eczema coxsackium" and unusual cutaneous findings in an enterovirus outbreak. Pediatrics. 2013;132:e149–57.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Leung AK, Szabo TF. Erythema multiforme following diphtheria-pertussis-tetanus vaccination. Kobe J Med Sci. 1987;33:121–4.PubMedGoogle Scholar
  57. 57.
    Leung AK. The natural history of molluscum contagiosum in children. Lancet Infect Dis. 2015;15:136–7.PubMedGoogle Scholar
  58. 58.
    Leung AKC, Barankin B, Hon KLE. Molluscum contagiosum: an update. Recent Pat Inflamm Allergy Drug Discov. 2017;11:22–31.PubMedGoogle Scholar
  59. 59.
    Berger EM, Orlow SJ, Patel RR, Schaffer JV. Experience with molluscum contagiosum and associated inflammatory reactions in a pediatric dermatology practice: the bump that rashes. Arch Dermatol. 2012;148:1257–64.PubMedGoogle Scholar
  60. 60.
    Leung AK, Leong KF, Lam JM. Onychomadesis in a 20-month-old child with Kawasaki disease. Case Rep Pediatr. 2019;3156736. https://doi.org/10.1155/2019/3156736.Google Scholar
  61. 61.
    Leung AK, Hon KL, Robson WL. Atopic dermatitis. Adv Pediatr. 2007;54:241–73.PubMedGoogle Scholar
  62. 62.
    Leung AK, Robson WL. Picture of the month. Pityriasis lichenoides et varioliformis acuta. Arch Pediatr Adolesc Med. 2005;159:978–9.Google Scholar
  63. 63.
    Leung AK, Robson WL. Hemorrhagic bullous lesions in a child with Henoch-Schönlein purpura. Pediatr Dermatol. 2006;23:139–41.PubMedGoogle Scholar
  64. 64.
    Retrouvey M, Koch LH, Williams JV. Gianotti-Crosti syndrome following childhood vaccinations. Pediatr Dermatol. 2013;30:137–8.PubMedGoogle Scholar
  65. 65.
    Jacobson RM, St Sauver JL, Finney Rutten LJ. Vaccine hesitancy. Mayo Clin Proc. 2015;90:1562–8.PubMedGoogle Scholar
  66. 66.
    Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351:637–41. Erratum in: Lancet 2004;363:750. Retraction in: Lancet 2010;375:445.Google Scholar
  67. 67.
    Leung AK, Hon KL, Leong KF, Sergi CM. Measles: a disease often forgotten but not gone. Hong Kong Med J. 2018;24:512–20.PubMedGoogle Scholar
  68. 68.
    Metelitsa AI, Fiorillo L. Recurrent Gianotti-Crosti syndrome. J Am Acad Dermatol. 2011;65:876–7.PubMedGoogle Scholar
  69. 69.
    Atanasovski M, Dele-Michael A, Dasgeb B, Ganger L, Mehregan D. A case report of Gianotti-Crosti post vaccination with MMR and dTaP. Int J Dermatol. 2011;50:609–10.PubMedGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine 2019

Authors and Affiliations

  1. 1.Department of PediatricsThe University of CalgaryCalgaryCanada
  2. 2.The Alberta Children’s HospitalCalgaryCanada
  3. 3.The University of AlbertaEdmontonCanada
  4. 4.Departments of Pediatrics, Dermatology and Skin SciencesUniversity of British ColumbiaVancouverCanada
  5. 5.Pediatric InstituteKuala Lumpur General HospitalKuala LumpurMalaysia

Personalised recommendations