Asymmetric Periflexural Exanthem of Childhood

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In 1962, Brunner et al reported a “new papular erythema” in 75 children aged 6 months to 5 years. [1] Later, in 1992, Bodemer and de Prost published a case series of 18 children and named the condition unilateral laterothoracic exanthem (ULE). [2] In 1993, Taieb and colleagues suggested the term asymmetric periflexural exanthem of childhood (APEC) to replace ULE, as the latter did not fully depict the morphologic distribution of the skin lesions present in this condition. [3] Asymmetric periflexural exanthem of childhood is classified as a rare selflimited and spontaneously resolving exanthem with unknown etiology that occurs . [4] To date, only 3 case presentations in adults have been documented. [5, 6, 7]

The etiology of asymmetric periflexural exanthem of childhood is unknown. The patient’s history (eg, age at presentation, multiple affected children in a family), lack of efficacy of broadspectrum antibiotic treatment, serologic findings, and the tendency for presentation during spring and winter raise the possibility of a viral etiology. [8, 9, 10, 11] However, the evidence has been inconclusive, and clinicians have not been able to isolate a specific virus. Therefore, this hypothesis has never been confirmed.

Asymmetric periflexural exanthem of childhood manifests as an exanthem with stereotypical morphology and distribution. is rarely if ever performed, as the presentation of this condition is unique and resolves spontaneously without treatment or adverse sequelae.

The exact cause of this eruption is unknown, and no specific viral pathogens have been identified.

United States

Asymmetric periflexural exanthem of childhood is a relatively rare condition that often appears in spring and winter months.

International

Approximately 300 cases have been reported in the literature. Case series of affected children have been documented internationally from the United States, Canada, and Europe.

Asymmetric periflexural exanthem of childhood predominantly affects individuals from light-skinned ethnic groups.

Asymmetric periflexural exanthem of childhood tends to affect females more frequently than males, with an estimated female-to-male ratio of 2:1.

The average age of presentation is 2 years, though affected children may be aged 4 months to 10 years. Four cases of asymmetric periflexural exanthem of childhood in adults have been reported in the literature.

The prognosis is excellent; the course of asymmetric periflexural exanthem of childhood is self-limited and spontaneously resolves in 4-6 weeks without medical intervention.

The unique presentation and appearance of skin lesions may be a cause of significant concern to the patient and his or her or caregivers. The patient should be educated and reassured that asymmetric periflexural exanthem of childhood a benign, self-limited exanthem without sequelae (eg, systemic symptoms, post-inflammatory hyperpigmentation, scarring, other skin changes).

For patient education resources, visit the Skin, Hair, and Nails Center. Also, see the patient education articles Skin Rashes in Children and Swollen Lymph Nodes.

Brunner MJ, Rubin L, Dunlap F. A new papular erythema of childhood. Arch Dermatol. 1962 Apr. 85:539-40. [Medline].

Bodemer C, de Prost Y. Unilateral laterothoracic exanthem in children: a new disease?. J Am Acad Dermatol. 1992 Nov. (5 Pt 1):693-6. [Medline].

Taieb A, Megraud F, Legrain V, Mortureux P, Maleville J. Asymmetric periflexural exanthem of childhood. J Am Acad Dermatol. 1993 Sep. 29(3):391-3. [Medline].

Arun B, Salim A. Transient linear eruption: asymmetric periflexural exanthem or blaschkitis. Pediatr Dermatol. 2010 May-Jun. (3):301-2. [Medline].

Bauza A, Redondo P, Fernandez J. Asymmetric periflexural exanthem in adults. Br J Dermatol. 2000 Jul. 143(1):224-6. [Medline].

Chan PK, To KF, Zawar V, Lee A, Chuh AA. Asymmetric periflexural exanthem in an adult. Clin Exp Dermatol. 2004 May. 29(3):320-1. [Medline].

Corazza M, Virgili A. Asymmetric periflexural exanthem in an adult. Acta Derm Venereol. 1997 Jan. 77(1):79-80. [Medline].

Auvin S, Imiela A, Cuvellier JC, Catteau B, Vallee L, Martinot A. Asymmetric periflexural exanthem of childhood in a child with axonal Guillain-Barre syndrome. Br J Dermatol. 2004 Feb. 150(2):396-7. [Medline].

Guimera-Martin-Neda F, Fagundo E, Rodriguez F, et al. Asymmetric periflexural exanthem of childhood: report of two cases with parvovirus B19. J Eur Acad Dermatol Venereol. 2006 Apr. 20(4):461-2. [Medline].

Harangi F, Varszegi D, Szucs G. Asymmetric periflexural exanthem of childhood and viral examinations. Pediatr Dermatol. 1995 Jun. 12(2):112-5. [Medline].

Pauluzzi P, Festini G, Gelmetti C. Asymmetric periflexural exanthem of childhood in an adult patient with parvovirus B19. J Eur Acad Dermatol Venereol. 2001 Jul. 15(4):372-4. [Medline].

Patricia T Ting, MD, MSc, FRCPC, LMCC(Canada) Clinical Assistant Professor, University of Calgary Faculty of Medicine, Canada

Patricia T Ting, MD, MSc, FRCPC, LMCC(Canada) is a member of the following medical societies: Alberta Medical Association, American Academy of Dermatology, American Society for Dermatologic Surgery, Canadian Dermatology Association, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Abbvie; Cipher; Galderma; Janssen; Leo Pharma; Novartis; PediaPharma; Pfizer; Procter & Gamble; Prollenium; Tribute Pharma; Valeant<br/>Serve(d) as a speaker or a member of a speakers bureau for: Valeant<br/>Received income in an amount equal to or greater than $250 from: Abbvie; Cipher; Galderma; Janssen; Leo Pharma; Novartis; PediaPharma; Pfizer; Procter & Gamble; Prollenium; Tribute Pharma; Valeant.

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for MOHS Surgery, Association of Military Dermatologists, Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of , Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Timothy McCalmont, MD Director, UCSF Dermatopathology Service, Professor of Clinical and Dermatology, Departments of and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Asymmetric Periflexural Exanthem of Childhood

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