Published: Infantile Acropustulosis in Internationally Adopted Children

I have gotten a number of emails from people due to the recent thread on APV regarding recurrent pustular outbreaks on the hands and feet of children who have already been adequately treated for scabies.

As I was gently nudged by a few of your requests, I did submit a response to that thread.  Unfortunately, it must have been weeded out by the moderators of the APV group on accident, because it still has not appeared amongst the new messages.  I realize moderating that site is volunteer based and time intensive, I just find it to be a little frustrating to use that resource since there is about a 3-7 day delay to our postings (and in my case, I spent a lot of time typing out a response to the thread on acropustulosis and it was never posted).  Personally, I don’t see the need for a moderator on that site given the extensive process you have to go through to become a member.  I think it’s redundant to check all membership applications AND continue to pre-approve each individual post.  But that’s just me.  Anyway, I’ll respond to that thread here, so if people could pass this along to those APVers who were searching for more info on “recurrent, itchy bumps on the hands and feet of their adopted kids,” it’d be greatly appreciated.

Many of you have inquired to find out whatever happened with my study on infantile acroputulosis.  It was published and the full-text just became available via Epub ahead of print in May.  I do apologize for the delay, but the publication process can take close to a year once something is accepted to a competitive journal.  This article was accepted to the Journal of the American Academy of Dermatology (also known as The Blue Journal or JAAD, www.eblue.org), which is the most widely read and most highly respected dermatology journal.  That is fantastic considering the goal of the research was to increase physician awareness of this condition.  Unfortunately, you cannot access the full article unless you go to a medical library that subscribes (or buy it in pdf form for $31.50, but I think that’s a bit pricey for 1 article!).  If you are interested in the brief version, here is the link to the pubmed abstract:

http://www.ncbi.nlm.nih.gov/pubmed/21632152

The full-text article is quite lengthy and has several images of IA (some taken by me, others by people with children involved in the study), as well as a histologic image of a biopsied case we had.  You’ll also notice Travis is an author on this publication - he calculated all our statistics.

You can at least print the abstract and give it to your pediatrician/family doc if you think your child has this and has not been diagnosed or your pediatrician has never heard of this entity.  In response to 1 specific post on APV, infantile acropustulosis is NOT contagious.  That said, there are other diseases and infections on the differential diagnosis that are, so you really need to verify a diagnosis like this with your pediatrician or dermatologist.

Thank you to all those who participated!!  Hopefully it’ll better prepare pediatricians, family docs, and even dermatologists to recognize this in internationally adopted kids.  The other result of the study you may not be aware of is the coincidence between infantile acropustulosis and eczema (referred to more specifically as “atopic dermatitis” in the article and abstract).  Interestingly, ~50% of kids w/ acropustulosis in the study also have eczema, and an old study showed a similar incidence in that subpopulation.  There’s no cause and effect implicated and the sample size was too small to make any generalizations, just something to be aware of in our kids, and something professionally I find fascinating.