Pediatric papular dermatitis syndrome
Introduction
Brief introduction of children with papular dermatitis syndrome The disease was first reported by Gianotti in 1955, and Crosti was reported in 1957, so the disease is also known as Gianotti-Crosti syndrome. The main features are erythematous papules on the extremities, superficial lymph nodes, and no jaundice hepatitis. This disease is also called itch-free apical dermatitis in children. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: hepatitis
Cause
The cause of papular cutaneous dermatitis syndrome in children
Cause:
It is caused by hepatitis B virus whose surface antigen is ayw subtype.
Pathogenesis:
Only through the digestive tract, the primary disease of the skin mucosa can only occur in the disease, blood transfusion or injection infection is not sick, using immunofluorescence to detect rash found that there is an excess of HBsAg-Ab complex on the small blood vessel wall of the rash. Sex deposition, which may play a role in the formation of rash, is considered to be a special type of hepatitis B with rash as the main manifestation.
Prevention
Prevention of papular cutaneous dermatitis syndrome in children
Timely detection of timely treatment.
Complication
Complications of papular dermatitis syndrome in children Complications
Hepatitis usually occurs 1 to 2 weeks after the rash or rash.
Symptom
Pediatric papulitis dermatitis syndrome symptoms common symptoms papule skin pigmentation deep diarrhea liver function abnormal lymph node enlargement scaly leaf depigmentation
The age of onset is from 6 months to 15 years old, but mainly occurs in children between 2 and 6 years old. The child may have no prodromal symptoms, but often has diarrhea or upper respiratory tract infection. The rash is symmetrically from the distal extremities. Stretched to the side, 3 to 4 days quickly spread to the face, arms and other places, but the trunk is rare, does not invade the oral mucosa, no symptoms, the basic damage is dark red or wine-like red flat papules, the boundary is clear, isolated and scattered without fusion, Lower extremity damage can develop into purple-like lesions. In the elbows, knees and hands, the back of the feet is similarly susceptible to mechanical stimulation, and there is a linear arrangement. The size of a single rash varies with age. Generally, the older the rash, the bigger the rash. The diameter can reach 5~10mm. The rash of the older age is 1~2mm, but in the same child, the size of the rash is more consistent. The skin lesions usually fade after 3~4 weeks, leaving temporary brown pigment and suede. Sample scales.
Superficial lymph nodes in the whole body are obvious in the axillary fossa and groin. It can last for 2 to 3 months. There is no pain in the lymph nodes. Generally, hepatitis occurs at the same time as rash or rash after 1 or 2 weeks. It is characterized by hepatomegaly and abnormal liver function. However, there is no tenderness or self-conscious symptoms, more than 95% of which are jaundice-free hepatitis, only 5% of cases, those aged over 6 years old, more often appear jaundice 3 weeks after the appearance of rash, patients may have mild fever, but the general condition is good .
Examine
Examination of children with papular dermatitis syndrome
ALT and AST increased, blood bilirubin was normal, white blood cell count was normal or decreased, monocytes could be increased, serum protein electrophoresis increased in acute phase 2 and globulin, and later gamma globulin increased, detected by serology and PCR. Hepatitis B virus antigen can give positive results.
Histopathology: mild or moderate acanthosis and hyperkeratosis in the epidermis, edema in the upper part of the dermis, telangiectasia, infiltration of lymphocytes and histiocytes around the lymph nodes, diffuse reticulocyte proliferation in the lymph nodes, rash on the rash The small vascular endothelial cells in the upper part of the dermis have a tiny tubular mass of 20 nm in diameter, and the hepatitis B virus antigen structure can be found in both lymph nodes and liver electron microscopy.
Diagnosis
Diagnosis and diagnosis of papular cutaneous dermatitis syndrome in children
According to the characteristics of rash, clinical and laboratory evidence of superficial lymphadenopathy and jaundice-free hepatitis, diagnosis is not difficult.
In the past, it was considered that it should be differentiated from pediatric herpes simplex dermatitis without hepatitis. According to the 5th World Congress of Pediatric Dermatology, it is considered that the skin lesions cannot be identified.
