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Asymmetric Periflexural Exanthem of Childhood - Causes, Diagnosis, and Treatment

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Asymmetric periflexural exanthem of childhood is a skin condition occurring more commonly in children as rashes and pruritus. This article explains this condition in detail.

Medically reviewed by

Dr. Veerabhadrudu Kuncham

Published At November 10, 2022
Reviewed AtNovember 10, 2022

Introduction

Asymmetric periflexural exanthem of childhood (APEC) is an uncommon clinical condition characterized by the presence of rashes on the sides of the trunk in young children. It is also called the laterothoracic exanthem. In 2014, a new name was proposed for this condition called superimposed lateralized exanthem of childhood.

History

Brunner et al had mentioned a "new papular erythema" in 1962 among 75 children aged 6 months to 5 years. Then, in 1992, Bodemer and de Prost reported many cases (nearly 18 children), and the condition was named as unilateral laterothoracic exanthem (ULE). The term asymmetric periflexural exanthem of childhood (APEC) was suggested by Taieb and colleagues in 1993 to replace ULE, as the previous name did not mention the complete presentation of this skin lesion. APEC has been reported in the literature as a rare exanthema that is self-limiting and resolves spontaneously. The etiology is not clear and more commonly children have been affected. Only 3 adults have been known to get affected by this condition as per literature.

How Is It Caused?

The exact etiology of this skin condition is not known. The specific virus or other microorganism causing it has not been identified.

What Is The Mechanism Behind This Condition?

As we know, the cause of asymmetric periflexural exanthems of childhood has not been established till now. Thus, it makes the pathophysiology of this condition unclear. The possible etiology is thought to be a virus due to the history of the patient like the presentation age, more than one child affected in a family, no response to antibiotic treatments, serologic findings, and more incidence of these cases during spring and winter. However, this possibility has not been proven yet as there is no evidence for the same. The most common manifestation of this condition is exanthem which is rashes on the body with a typical distribution and presentation in the body. Since it is self-limiting, a biopsy is rarely done.

What Is The Distribution Of This Condition?

Frequency: The literatureshows nearly 300 children being affected by this condition. The most cases have been reported in the United States, Europe, and Canada.

Gender: This condition affects females more commonly than males and the ratio between females to males is 2:1. Thus, females are more prone to develop this condition when compared to males.

Race: Light-skinned people tend to develop it more commonly than dark-skinned people.

Age: The literature reports the average age at which this condition can be manifested is 2 years. but children between 4 months to 10 years can be affected. Three to four cases have also been mentioned in adults.

How Is The Prognosis?

The prognosis of this condition is excellent as its course is self-limited and resolves spontaneously within four weeks to six weeks without any medical intervention.

How Can It Be Diagnosed?

History: When you visit your physician, you will be asked about the signs and symptoms the child is facing which can be a current and/or recent episode of infection related to the upper respiratory tract, swelling of lymph nodes, fever, otitis media, or loose motions. Most of the children tend to be asymptomatic and appear to be healthy without any other medical condition. In rare cases, more than one child in the family might have asymmetric periflexural exanthem of childhood. Nearly 50% of the affected children tend to have mild pruritus.

Physical Examination: On physical examination, the child will have the primary (pathognomonic) lesion which is a small red papule with a surrounding pale border. The more common appearance includes papules or rashes which can be occasionally associated with fine scaling.

In the beginning stages, the lesions affect one side and usually start to appear near the axillae, lateral body, and upper inner arm or groin. Later on, the lesion may progress to develop on both sides of the body and tend to be asymmetric.

There are four sequential stages of the lesions which include the following:

  1. Eczematous stage in which the initial lesions occur on the axillary and lateral chest wall.

  2. Coalescence stages in which the lesions extend to the center of the body, hands and legs. They tend to be separated by areas of normal skin.

  3. Regression stage in which the older lesions tend to develop into a dusky-gray center.

  4. The desquamation stage is in which the remaining residual scale develops and resolves later.

The face, palms, soles, and mucous membranes are not affected by this condition.

Laboratory Tests: There are no specific laboratory tests that are required to diagnose APEC. Although, erythrocyte sedimentation rate can be elevated in these children. Parvovirus B19 has been seen to be associated with asymmetric periflexural exanthemism of childhood in many children. In rare cases, serologic results can become positive for respiratory pathogens like adenovirus and parainfluenza virus. Also, many studies have revealed negative serologic results for hepatitis, Mycoplasmaorganisms, borreliosis, Epstein-Barr virus, cytomegalovirus, coxsackievirus, HIV, toxoplasmosis, and rickettsiae.

What Are The Other Conditions That Mimic This Condition?

The various conditions that can be similar to APEC are as follows:

· Allergic Contact Dermatitis.

· Miliaria.

· Tinea Corporis.

· Milia.

· Lichen striatus.

· Pityriasis Rosea.

· Dermatologic Manifestations of Gianotti-Crosti Syndrome.

· Scabies.

· Scarlet Fever.

How Can It Be Treated?

As mentioned earlier, it is a self-limiting condition and thus, does not require any specific medical management. Although, low-potency topical steroids can be used for symptomatic relief. Hydroxyzine can be helpful to manage pruritus. Moisturizers are also recommended to manage pruritus and fine scaling.

Conclusion

Asymmetric periflexural exanthem of childhood (APEC), also called laterothoracic exanthem is a clinical condition affecting the skin of children. The etiology is not known. Although it is self-limiting, symptomatic relief can be provided using some topical medicines. Online medical platforms have emerged recently which has made communicating with a physician easy and comfortable. You can know about the causes, management, and other details about this condition by consulting a specialist through these online medical platforms.

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Dr. Veerabhadrudu Kuncham
Dr. Veerabhadrudu Kuncham

Pediatrics

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