Thursday, August 20, 2009

Acropustulosis

Catchy title, huh? Do you remember last summer when K. ended up in the hospital with a bacterial infection? The doctors finally settled on a recurrence of the scabies infection he had when we first met him, although the skin scratch test was negative and no one else in the family had any symptoms. I think the mystery is solved. The is a little known skin disease called acropustulosis which can come as a result of having scabies. The symptoms sound exactly like what K. has off and on. An adoptive mother, who is also a doctor, is trying to do a study on it, because though it is relatively unknown, it seems many internationally adopted children have it. The following is from Laurie Good, the doctor doing the study. If you are interested in taking her survey, please be aware that she will only leave it up for another couple of weeks.


I am an adoptive parent of 2 awesome little boys from Vietnam, one of whom has had continual outbreaks from a disease called acropustulosis. I am also a medical doctor, doing research in dermatology, and believe that this disease entity is LARGELY under-diagnosed in internationally adopted kids. My belief is that, while considered "rare," it is actually quite prevalent in the population of internationally adopted pediatric patients.

It often occurs after a scabies infection, and usually manifests as recurrent pustular (blister) outbreaks around the hands and feet in kids under 3 who were previously infested with scabies. These blisters ITCH, crop up in groups, then resolve, and a few weeks or months later, new ones appear just like the previous batch.

I know many AP's have bounced from doctor to doctor trying to get a diagnosis and find an effective treatment for their child's pustular outbreaks. Many of your kids have been treated repeatedly and unnecessarily for scabies infections or other unrelated dermatologic diseases such as hand-foot-mouth, when what they really have could be acropustulosis. While acropustulosis has been written about in dermatology literature, there isn't much that's understood about it and no one has any idea of the incidence. My interest is in highlighting, again, the connection between scabies and acropustulosis and investigating the incidence of acropustulosis in children who had previous scabies infections. Specifically, I am interested in drawing attention to this disease in internationally adopted kids so that it is recognized by pediatricians, family docs, and dermatologists as a common complication of scabies that occurs relatively frequently in immigrant children.

To do this, I am writing a case series on adopted children with acropustulosis after scabies infection in the hope that it garners more support in the dermatology community to launch a larger prospective study in collaboration with the large International Adoption clinics in this country. If your child has had any such skin findings (recurrent, itchy, pustular outbreaks around the hands and feet after a scabies infection), please consider contacting me and/or filling out this survey that will take 10 minutes or less of your time:

http://www.surveymonkey.com/s.aspx?sm=6uvfIO49RQkCdOaRzy0QhA_3d_3d

If it sounds like your child could have acropustulosis, I will follow up with you and ask that you sign a medical release form so that your child's medical information can be included in this case series. NO IDENTIFYING FEATURES WHATSOEVER will be used that could possibly link your child to any published information. If you have any concerns, questions, or comments, my email address is: laurie at goodhappenings dot com

2 comments:

Taylor said...

I found this website because, while I don't think that I have acropustulosis, I do have a horrible reoccuring itch from having an undiagnosed case of scabies 7 years ago for about 10 wks. One of the worst places that itched during the outbreak was the bicep area of both arms.
There was never any presentation of the mite there but it was the most affected. It itched for months after and my MD theorized that a parasympathetic pathway had been built somehow for this chronic itching. She suggested a round of steroids that I declined and it finally went away. However, about once every year or so, this intense itching returns for about 1-2 weeks. It's unfathomable to me that it is scabies related. HOwever, it is the most intense itch, like none other, and feels exactly the same as when I had the actual bugs on my skin.
Anyone ever heard of this. thanks.

Anonymous said...

My granddaughter who is29 months old has a pustular, red, itchy rash on her right foot on and between the 4th and 5th toes. She was diagnosed with scabies at 17 months of age and the whole family was treated. ABout 10 weeks later she developed this pustular rash on the toes. She was re treated with permethrin cream along with the rest of the family. For 6 months she had no rash. Then it came back in Jan. 2012. The pediatrician says it is not scabies but it looked like scabies and caused itching. I treated her with the elimite again and it resolved. Its back again right now. I am going to assume this is acropustulosis unless I see it spreading or infesting others. Why do doctors not know about this? I mean I feel so relieved knowing that this is possibly acropustulosis. I was really starting to worry that she was having recurrent scabies due to immunosupression or a compromised immune system. But nobody else has ever gotten scabies in the house. and it seems cyclic and looks like scabies. Its always in the same area and is itchy. The dermatology office told me it was highly unlikely it was scabies over again but couldnt tell me what it was. in fact they wouldnt even give her another appointment. I am glad I have a nursing background and performed my own research or id probably be slathering elimite all over her again.

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