Asymmetrical perifluxural and unilateral mediothoracic exanthema R21

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

APEC; Asymmetrical periflexural exanthem; Asymmetrical periflexural exanthema of childhood; Exanthema asymmetric periflexural; ULE; Unilateral laterothoracic exanthema; Unilateral latero-thoracic exanthema in childhood

History
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Brunner et al. 1962

Definition
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Self-limiting, 4-6 weeks lasting, probably infect-allergic skin disease of childhood.

Occurrence/Epidemiology
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Very rare occurrence. Mostly in individual children; occasionally in smaller epidemics.

Etiopathogenesis
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A triggering agent has not yet been described. An infectious or parainfectious genesis in connection with previous viral infections (parovirus B19, parainfluenza 2 viruses, parainfluenza 3 viruses, Epstein-Barr viruses, adenoviruses) is being discussed.

Manifestation
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Mostly in small children between 6 months and 10 years (average age: 2-3 years). Girls are more frequently affected than boys. The very rare occurrence in adults is described in individual cases. Seasonal accumulation of the occurrence in spring.

Localization
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Thorax, usually beginning in the axillae, then spreading to one half of the trunk, but also upper extremity and buttocks. Occasionally also symmetrical infestation!

Clinical features
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Mostly after infection with mild catarrhal or gastrointestinal symptoms (60% of patients), unilaterally localized exanthema with partly disseminated, partly following the Blaschko lines, maculo-papular, scaly inflammatory efflorescences; occasionally also lichenoid skin lesions; moderate itching (2/3 of cases); accompanying lymphadenopathy possible.

Laboratory
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Non-specific

Histology
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Non-specific, superficial perivascular lymphocytic dermatitis with mild spongiosis and exocytosis

Differential diagnosis
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Therapy
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Make parents aware of the harmlessness of the disease pattern; also of the self-limiting course! Antihistamines for itching; bland-nursing external agents.

Progression/forecast
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Benign course; healing of the exanthema after 3-6 weeks.

Literature
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  1. Bodemer C, Prost Y (1992) Unilateral laterothoracic exanthem in children: an new disease? J Am Acad Dermatol 27: 693-696
  2. Brunner MJ et al (1962) A new papular erythema of childhood. Arch Dermatol 85: 539-540
  3. Mc Cuaig C et al (1996) Unilateral laterothoracic exanthem. J Am Acad Dermatol 34: 979-984
  4. Peker S et al (2000) Unilateral laterothoracic exanthema. Case report and review of the literature. dermatologist 51: 505-508
  5. Scott LA et al (2003) Viral exanthems. Dermatol Online J 9: 4
  6. Strom K et al (1999) Unilateral latero-thoracic exanthema in childhood. Clinical characteristics and diagnostic criteria in 5 patients. dermatologist 50: 39-44
  7. Taieb A et al (1993) Asymmetric periflexural exanthem of childhood. J Am Acad Dermatol 29: 391-393

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Last updated on: 29.10.2020