(BMJ)—An otherwise healthy 2-yo boy presented w/ a 4-wk hx of a widespread itchy rash that appeared 6 days after he received the MMR vaccine. The rash started on his face and spread to his limbs. Exam: afebrile; monomorphic erythematous papules, some w/ crusts, in a symmetrical distribution over face, hands, buttocks, feet, and upper/lower limbs; trunk was spared. What is the dx?
Papular acrodermatitis of childhood
Atopic dermatitis
Measles
Papular urticaria
Varicella
You are correct. Papular acrodermatitis of childhood (PAC), also called Gianotti-Crosti syndrome, is a self-limited rash w/ symmetrical acral distribution, affecting children ages 1-6 yo. In addition to viral infxns, PAC may occur after immunizations, including MMR, Haemophilus influenzae type b, and oral polio vaccine. Dx is made on clinical basis. The dz is self-limited; complete resolution may take up to 12wk, w/o scarring. No tx was indicated for this pt, and the rash disappeared 38 days after onset. Clinicians should be aware of this condition after vaccination, to avoid unnecessary exams and treatments.

Archives of Disease in Childhood 2019;104:706.
By vgreene, 10 July, 2019

RET