Gianotti-Crosti syndrome is a set of dermatological symptoms that occur against the background of infectious processes. The pathology is expressed in the appearance of rashes on the skin of the face, gluteal muscles and limbs. The disease is often accompanied by concomitant symptoms that affect other organs (liver, lymph glands, spleen).

When was the pathology discovered?

About sixty years ago, the disease was discovered by a doctor named Gianotti. The doctor observed a patient with enlarged lymph glands, signs of liver inflammation and red rashes in the form of nodules that were located on the skin of the face, buttocks, arms and legs. Initially, the specialist assumed that indicated symptoms associated with the penetration of microbes into the body. The pathology was named after the two doctors - Gianotti-Crosti syndrome. A synonym for this term is the phrase “acrodermatitis papular.” The disease refers to inflammatory diseases of the skin.

The main factors contributing to the development of pathology

The syndrome is infectious in nature. The doctor who first described it believed that the disease was associated with exposure to the hepatitis B virus.

According to the specialist, papular acrodermatitis in pediatric patients is considered one of specific signs liver inflammation. Therapy for Gianotti-Crosti syndrome was carried out simultaneously with treatment of the underlying disease. Several years later, signs of a similar disease were discovered in an individual who did not suffer from type B hepatitis. Consequently, the pathology can develop against the background of other infectious processes.

At-risk groups

Gianotti-Crosti syndrome is classified as a rare disorder. Modern research showed that its occurrence is not associated with the presence of a hereditary predisposition. People of both sexes are susceptible to pathology, but boys are slightly more likely to get sick, and average age patients is two years. The disease occurs in both children and adolescents. In adults, it is found extremely rarely (usually in the presence of hepatitis type B). In general, Gianotti-Crosti syndrome is diagnosed in patients between six months and fourteen years of age. The largest number of cases is detected in the autumn and winter. Some patients with this pathology have been diagnosed with the Epstein-Barr virus, which causes the development of infectious mononucleosis.

Main signs of the disease

With Gianotti-Crosti syndrome, children and adults experience approximately the same symptoms. Manifestations of pathology begin with the appearance of plaques and nodes on the surface of the face, legs, arms, and gluteal muscles. The rash is often accompanied by a feeling of itching. Other signs of the disease are usually mild. However, upon examination, the doctor discovers an increase in the volume of the patient’s liver, lymph glands, spleen, ulcers in the oral cavity, inflammatory processes in the throat elevated temperature.

Features of manifestations

Continuing to talk about Gianotti-Crosti syndrome, the causes and symptoms of the condition, it should be noted that the signs of the disease are determined by the nature of the concomitant diseases. For example, in the presence of infectious mononucleosis, rashes appear only on the surface of the face.

As a rule, nodules do not rise above the surface of the skin. They have approximately the same appearance. There are no ulcers or blisters observed in patients. With this condition, the rash never appears on the patient's torso. The nodules are small in size (from one to five millimeters) and have a dense structure. In appearance they resemble domes. Rashes often form in areas of mechanical damage to the skin. The nodules often join together at the elbows and knees, forming large areas of dermatitis. They most often have a bright red tint. However, some patients have crimson and pinkish papules. It is quite difficult to detect such rashes.

Stages of development of Gianotti-Crosti syndrome

When microbes enter the body, they spread infectious process with blood into the skin area. As a result of exposure to the virus the immune system patient starts special mechanism, causing inflammation and the appearance of a rash.

This reaction is similar to allergy symptoms. The spread of nodules is usually observed within seven days. In this case, rashes appear in the area of ​​new areas of the epidermis. The papules disappear completely within two to eight weeks.

Types of ailments that can provoke pathology

A factor contributing to the onset of the disease is infection with the hepatitis B virus or mononucleosis. However, the disease develops against the background of other ailments. Among them are:

1. Parainfluenza.
2. Intestinal infection.
3. Rubella.
4. Ailments caused by herpes of any type.
5. Rotavirus infection.

In addition, experts say that papular acrodermatitis sometimes develops in young patients after receiving vaccines against measles, tetanus, polio, whooping cough and other childhood diseases.

In recent medical research There is information that the pathology occurred in children as a result of infection with meningitis pathogens, mycoplasma and group A streptococci.

Ailments with similar symptoms

It is necessary to carry out differential diagnosis of the syndrome with the following conditions:

• Arthropod bites. With this disease, the rashes are asymmetrical. A dotted mark is visible on the affected area of ​​the epidermis.
• Atopic form of dermatitis, which is accompanied by the appearance of nodules on the surface of the skin.

The pathology is chronic with periodic relapses.

• Red lichen planus. The disease is accompanied by the appearance of crimson papules with a white coating. They are located on the mucous membrane of the cheeks, the bend of the wrists and in the area of ​​the legs.
• Medicinal satiety. Observed after taking a certain drug, it covers the entire surface of the body (torso, limbs).

Diagnostic measures and methods of therapy

How to detect Gianotti-Crosti syndrome? In order to identify this pathology, it is necessary to carry out laboratory analysis blood. Patients experience a decrease in the number of leukocytes and an increase in the number of lymphocytes. These signs refer to nonspecific symptoms of viral diseases. In addition, it is important to check the blood for the presence of hepatitis type B.

When Gianotti-Crosti syndrome is detected in children, treatment consists of taking medications with antihistamines, drugs that help lower body temperature, and vitamin supplements. In rare cases, experts recommend using products containing hormones (in the form of gels, sprays, creams) as a method of therapy. However, ointments that provide an antibacterial effect are prescribed quite often.

For severe itching, doctors usually recommend medications such as Suprastin and Loratadine. To alleviate the condition, the patient is advised to remain in bed. The patient needs to drink enough fluid to remove toxic compounds and bacteria from the body.

To date, no specific medication has been developed to get rid of the symptoms of acrodermatitis papularis. Signs of pathology go away on their own, even in the absence of therapy. But, despite the fact that the disease may seem relatively harmless, you should not try to cope with its manifestations on your own. It is necessary to consult a doctor.

Infantile acrodermatitis papularis

Skin diseases in children

Skin diseases in children
Professor, Department of Dermatovenereology, St. Petersburg State Pediatric Medical Academy
Zverkova F. A.

Children's papular acrodermatitis (acrodermatitis papular of children; disease, or Crosti-Gianotti syndrome; eruptive reticuloendotheliosis of the extremities).

In 1955, Gianotti first described a disease that he observed in 3 children and called “acrodermatitis papular in children.” In 1957, Gianotti and Crosti described in detail the clinical picture and features of the course of this dermatosis based on joint observations of 11 children. Subsequently published in both pediatric and dermatological journals different countries reports of individual observations usually appeared under the name Gianotti-Crosti syndrome.

It is possible that this dermatosis occurs more often in children than is diagnosed. Mostly girls aged from 6 months to 15 years are affected.

The disease is characterized by a sudden, acute onset, sometimes a rise in temperature to 38-39 °C and the appearance of a monomorphic papular rash located symmetrically, mainly on the extensor surfaces of the extremities. Gradually the rash may spread to shoulder girdle, neck, forehead, ears, buttocks and abdomen, less commonly it occurs on the face, scalp, back and chest. The mucous membranes are extremely rarely affected.

Typical papules range in size from 1 to 3 mm in diameter, are hemispherical or flat in shape, and have a stagnant red, copper-red or yellowish color. Elements of the rash are located on unchanged skin and, as a rule, do not tend to merge; only in some patients the papules merge into small polygonal plaques. During diascopy, the papules acquire a yellowish color. The affected skin resembles that of a leopard or giraffe. In some patients on the lower extremities, nodules are combined with petechiae; sometimes a positive Konchalovsky-Rumpel-Leede symptom is determined. Some children develop a rash on the body that resembles prickly heat, or pinpoint blisters appear on lenticular papules. After a few days, slight peeling begins in the center of the elements, gradually intensifying as the papules resolve. The latter last from several days to 1.5 months. After the rash disappears, no changes remain on the skin. There are no subjective sensations, only sometimes moderate itching may be noted.

Infections may occur early in the disease respiratory tract with slight fever, anorexia, slight enlargement of the liver and spleen; sometimes a measles-like rash appears, followed by a rash characteristic of this dermatosis. One of the important signs is an increase in the inguinal, femoral, axillary, cervical, and less commonly, elbow lymph nodes. They range in size from a pea grain to a bean, are painless on palpation, are of medium density, are not fused to the skin and underlying tissues, and the skin over them is not changed. Lymph nodes appear and disappear at the same time as the rash.

In peripheral blood, hypochromic anemia, eosinophilia, leukocytosis or leukopenia are detected.

According to our data, childhood papular acrodermatitis can occur in the form of 3 options:

1. cutaneous form without liver damage;
2. its combination with benign anicteric hepatitis;
3. cutaneous form with severe liver damage and obvious jaundice.

Benign hepatitis ends in 4-6-8 weeks. In more severe cases, the manifestations of hepatitis with jaundice last longer and occur with more pronounced general symptoms.

Etiology and pathogenesis.

There is information about the connection between childhood papular acrodermatitis and anti-smallpox, anti-myelitis vaccinations, focal infection, including tonsillitis. Indicate opportunity viral origin this disease, as evidenced by the combination with infection caused by hepatitis, Eptain-Barr, Coxsackie, and parainfluenza viruses. In addition, seasonal fluctuations in the incidence of this dermatosis, characteristic of viral diseases, have been established. There is also a direct connection between childhood papular acrodermatitis and hepatitis B.

In a number of cases, Australian antigen was detected in the blood serum of patients, despite the fact that the samples functional state livers were normal or were in upper limit norms. We observed such a picture in a patient aged 4 months. With papular acrodermatitis of children, accompanied by hepatitis B, skin rashes first appear, and after 10-15 days hepatitis appears, often persisting for a year. Sometimes, this hepatitis can sometimes take chronic course and even cause further post-necrotic cirrhosis in adults.

Treatment

Treatment must be differentiated. For mild forms of the disease, oral calcium supplements are prescribed. antihistamines, vitamins C, B in age-specific dosages. Indifferent shaken suspensions are used externally.

It is necessary to hospitalize sick children with functional studies liver, and if its pathology is detected, patients must be transferred to the infectious diseases department.

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Papular acrodermatitis or Gianotti-Crosti syndrome is a reaction to the introduction of a viral infection. The disease became known in 1955, and the infectious etiology of the disease was confirmed in 1970. The average age of those affected is 2 years, but cases of infection in adults are known. In this case, the disease does not require any special treatment, since the symptoms usually go away on their own after some time.

Causes

Acrodermatitis papularis occurs in response to the reintroduction of viral particles into the body. Symptoms occur more often when infected with hepatitis B or Epstein-Barr, and the disease may develop due to infection with other viruses. At the first contact of the body with the virus, antibodies are produced, which, when the agent enters again, begin to attack the cells of its own body.

The disease most often occurs in winter or autumn, when viral activity is especially high.

Symptoms

Gianotti-Crosti syndrome includes several main symptoms: a papular rash with rare vesicular elements, lymphadenopathy and hepatosplenomegaly. Papules are pink or reddish, up to 5 mm in diameter, appear symmetrically on the face, extensor surfaces of the joints, skin of the extremities and buttocks. The skin of the body is rarely affected. Papules are painless and do not itch. Elements of the rash appear and spread within seven days, gradually disappearing over 2-8 weeks.

The appearance of the rash is accompanied by an enlargement of the peripheral lymph nodes, and, less commonly, of the liver and spleen. There may be an increase in body temperature and an increase in general weakness.

Diagnostics

Diagnosis is based on assessment clinical picture and blood test data. Leukopenia or lymphocytosis is detected in the blood - nonspecific signs of viral infections. Specific tests are effective only when looking for hepatitis B; infection with this virus is usually ruled out first.

Treatment

Treatment of the disease is symptomatic and includes the use of antihistamines, antipyretics, and vitamin-mineral complexes. Rarely resort to the use of corticosteroid hormones; in its place, ointments with an antibacterial effect are prescribed.

To alleviate the condition, bed rest and drinking plenty of fluids are indicated.

Photo

Gianotti-Crosti syndrome

For some reason, we have developed a strange relationship with dermatological symptoms. On a scale possible dangers they are located much lower than, say, problems with digestive or circulatory system. A visit to a dermatologist is perceived as some kind of unimportant, or even shameful duty. With such a perception of reality, a certain itchy spot that has formed on one of the fingers does not receive our attention, for the time being hidden behind the vague formulation “it will go away on its own.” Over time, when the painful lesion spreads to the entire limb, a visit to the dermatologist becomes an urgent necessity, and medical card supplemented accurate diagnosis“acrodermatitis”, we ask ourselves a belated question: what is it?

Description of the disease

Acrodermatitis is not just something called separate disease with characteristic manifestations, causes of development and treatment methods, but a combination of different pathological conditions, united by some common features. Firstly, with this pathology, distant parts of the extremities - hands, feet - always suffer. Secondly, the damage occurs in the deep layers of the skin. Both of these signs are reflected in the name of the pathology: “akros” in Greek means “distant”, “derma” is translated as “skin”.

Classification

The most dangerous type of the disease is enteropathic, also known as Danbolt-Kloss syndrome or Brandt syndrome. The first symptoms of the disease develop in early infancy, and later remissions alternate with increasingly intensifying relapses. Each subsequent deterioration is tolerated by the body much more severely than the previous one, it is even possible death. Enteropathic acrodermatitis manifests itself not only on the skin of the child’s hands and feet, but also systemically - affecting the entire body, including internal organs.

Much more successfully, the child’s body fights the symptoms of atypical papular acrodermatitis, or Gianotti-Crosti syndrome. This seasonal condition, which occurs as a reaction to a viral infection, is tolerated quite easily and goes away on its own in 2–8 weeks without causing relapses.

The atrophic form of the disease also develops as a response to biological effect. It is provoked by Burgdorffer's borrelia, a harmful spirochete that enters the human bloodstream when bitten by an ixodid tick.

The causes of the chronic atrophic form, or Herxheimer-Hartmann syndrome, have not been precisely established. Most often it affects women over 40 years of age. The syndrome is accompanied unpleasant sensations in the limbs and numerous cosmetic defects, but does not pose an immediate threat to the patient’s life.

Allopeau syndrome can occur in any person, regardless of age and gender. Its manifestations, spreading from the nail area up the extremities, also cause severe discomfort in the patient and can cause profound changes in tissues, including extensive necrosis.

Causes and development factors

The development of childhood acrodermatitis enteropathica is attributed to hereditary mutations leading to insufficient accumulation of zinc in the child’s body. Digestive system the patient absorbs no more than 10% of this microelement supplied with food, while normal indicator makes up about 30% of absorption. According to statistical data, the likelihood of pathology occurring sharply increases in offspring from closely related marriages, which confirms the theory of genetic factors.

Allopeau syndrome presumably develops with temporary disturbances in work nervous system. If, due to past infections, stress or trauma, one or another area of ​​the skin is deprived of sensitivity, stagnant processes may begin in it. Over time, they turn into inflammation, on the surface of which ulcers (pustules) form.

Chronic atrophic dermatitis can develop as a reaction to the following phenomena:

• disruption of the endocrine glands;
• menopause;
• systemic infections;
• nervous system injuries;
• prolonged hypothermia.

Symptoms of the disease

Symptoms vary significantly depending on which type of it we are talking about.

Acrodermatitis enteropathica

The first manifestations of the disease occur in infancy, extremely rarely - later. Skin and intestinal symptoms develop simultaneously. The child suffers from loss of appetite and weight, diarrhea, and growth retardation. Swelling spreads on the skin, then numerous blisters appear, symmetrically located in the area:

• eye;
• hips;
• joint bends;
• armpits;
• buttocks;
• groin

As the disease progresses, the blisters turn into crusts and plaques. Soon nails, eyelashes and hair are affected, up to their complete loss. Inflammation spreads to the eyes and mucous membranes of the mouth, manifesting itself in stomatitis, erosions, conjunctivitis and blepharitis. Deterioration of the condition leads to photophobia, anemia, apathy, delays in mental development. At severe violations metabolism, death is likely.

Acrodermatitis papularis

Gianotti-Crosti syndrome develops when various pathogens multiply in the child’s body:

• adenoviruses;
• hepatitis B virus;
• herpes virus;
• influenza virus;
• rubella virus;
• parainfluenza virus;
• Staphylococcus aureus;
• streptococci;
• cytomegaloviruses.

The age of the patients ranges between 6 months and 14 years, in extremely rare cases deviating upward.

Papular dermatitis was first described in 1955 by Italian dermatologists Ferdinando Gianotti and Agostino Crosti, but its manifestations were mistaken by the discoverers for typical symptoms of childhood hepatitis B.

The rash on the affected skin forms small (1–5 mm) dense nodules (papules) that spread from the legs to the face. The body temperature rises slightly, and the lymph nodes become enlarged. In some cases, inflammation spreads to the upper respiratory tract, flowing into rhinitis and pharyngitis. Wherein skin symptoms rarely persist longer than 2–8 weeks, disappearing even without special treatment.

Acrodermatitis Allopo

Pustular pathology most often occurs on the tips of one or more fingers, eventually spreading higher up the limb. The affected area quickly swells, turns red, and a purulent mass begins to ooze from under the nail plates. Infected blisters (pustules), clear swellings (vesicles), or scales may form on the surface of swollen skin.

Fingers swell, lose shape and mobility. The nail plates become covered with cracks and grooves. With the rapid development of the purulent process, the nails may completely fall out.

In mild cases, the disease spontaneously regresses, in severe cases, tissue breakdown continues deep into the body and up the limb.

Atrophic

The first symptoms of the pathology develop some time (from 6 months to 5 years) after an infectious tick bite. As a rule, by this point Lyme disease is already gaining momentum, so acrodermatitis atrophica acts more as a background process.

Over time, the skin of the extremities becomes thinner, and bluish-dark spots appear on it. Then there is a smooth spread of foci of darkening, their compaction and atrophy. In place of the collapsed integument, trophic ulcers, pseudofibromas and wen can form.

Chronic atrophic

Chronic disease has three clearly defined stages of development.

In the first stage, the patient's skin becomes covered with a bright red rash. Some areas of the integument swell, thicken, and stretch. In such places, spots of lilac, violet or brick color appear, increasing over time.

The second stage is accompanied by thinning and sagging of the skin. Blood vessels become visible through the thin covers. Body surface appearance resembles crumpled tissue paper; when touched, the skin takes a long time to restore its original shape.

The third stage is characterized by hair loss in the affected areas, uneven skin color due to impaired pigment deposition, and sensations of pain, burning, and itching. Acrofibromatosis, the development of dense subcutaneous nodes located near the joints, is very common.

Diagnostic methods

The most informative method primary diagnosis is an external examination, during which a dermatologist examines the character skin lesions, their location, symmetry, possible complications.

Allows you to determine the content of protein metabolism enzymes (phosphatases, aminotransferases), bilirubin. A change in their concentration may indicate damage internal organs for enteropathic and papular acrodermatitis.

A general blood test is performed to confirm the inflammatory process, accompanied by an increase in the number of lymphocytes.

A urine test performed when acrodermatitis enteropathica is suspected determines the extent to which zinc is bound by the body's systems.

An immunological blood test can confirm the atrophic type of the disease if antibodies to Borrelia are detected during the test.

Polymerase chain reaction (PCR) is performed to precise definition a type of virus that causes Gianotti-Crosti syndrome.

Histological examination of the affected skin allows us to identify characteristic formations (sponge-like blisters, elongated processes of the epidermis) in Allopeau syndrome.

In case of severe liver damage, a tissue biopsy is required to distinguish between the manifestations of hepatitis B and the symptoms of Gianotti-Crosti disease.

Table: differential diagnosis

Treatment of acrodermatitis

The choice of specific treatment tactics depends on the type of acrodermatitis and the severity of symptoms. One way or another, but the selection necessary procedures and medications should be carried out only by a dermatologist, and only after conducting comprehensive diagnostic studies. Self-medication can lead to serious consequences.

Drug therapy

Treatment of enteropathic acrodermatitis is carried out primarily with the aim of replenishing zinc deficiency in the child’s body. Used as supporting agents vitamin complexes(A, B, C, E), gamma globulins, probiotics (Bifiform, Vivocaps, Linex). Antibacterial drugs (Diiodoquine, Enteroseptol) are used to fight infection. If the child’s condition sharply deteriorates, plasma transfusions may be performed.

Gianotti-Crosti syndrome often does not require special treatment. The main focus is on combating the viral agent that caused the disease. To remove local symptoms Ointments with corticosteroids (Mometasone, Methylprednisolone) and antihistamines (Suprastin) can be used.

Acrodermatitis atrophicum is treated during general therapy against Lyme disease. Good efficiency in the fight against bacterial pathogens, antibiotics (Doxycycline, Penicillin) are taken in 1–3 courses. Taking vitamin E promotes the rapid restoration of damaged tissues.

Video: treatment of tick-borne borreliosis

Treatment of chronic atrophic acrodermatitis is complicated by the fact that the causes of its occurrence have not yet been precisely established. In practice it is used complex treatment consisting of taking antibiotics wide range actions (Azithromycin, Penicillin, Ceftriaxone), vitamins A, C, E, PP, iron supplements, corticosteroids, skin softening ointments. If subcutaneous nodes rapidly enlarge, surgical removal is possible.

Treatment of pustular acrodermatitis is generally similar to the treatment of the chronic atrophic variety of the disease. In this case, painful blisters on the surface of the skin can be treated with aniline dyes (diamond green, methylene blue) and corticosteroid ointments. Immunosuppressants (Methotrexate, Cyclosporine) are used to inhibit the autoimmune process.

Diet

A special diet for acrodermatitis is not prescribed, since the patient receives all the necessary substances with the prescribed medicines. At the same time, it is advisable to ensure that daily diet there were products containing:

• vitamin A (apricots, carrots, liver, lettuce, plums),
• C (raspberries, currants, citrus fruits, apples),
• E (liver, sprouted cereal grains, eggs),
• RR (buckwheat, dairy products, coarse cereals, meat).

For enteropathic acrodermatitis, if the child’s age allows it, it is advisable to increase the amount of foods containing zinc - meat, fish, liver, kidneys, oysters, goat’s milk, pumpkin.

Physiotherapy

Alleviate the course of the disease and improve metabolic processes A variety of physiotherapeutic procedures are possible in the skin:

• PUVA therapy - exposure to ultraviolet radiation in combination with surface-acting psoralen preparations;
• Bucca's rays - the influence of ultra-soft x-rays;
• Warm mineral baths (permanganate, radon, hydrogen sulfide);
• Massage.

Folk remedies

Traditional medicine has created a large number of ointments and lotions that can relieve unpleasant symptoms at skin diseases, including for acrodermatitis.

Propolis ointment relieves itching and irritation, improves blood microcirculation and accelerates skin healing. To prepare it, mix 100 g of butter and 10 g of crushed propolis, boil for 10 minutes, then cool. The container with the mixture should be stored in the refrigerator. Best effect achieved with daily use.

Equally effective is an ointment consisting of the following components:

• 1 chicken egg white;
• 1 tsp. honey;
• 1 tsp. tar;
• 1/2 tsp. fish oil;
• 1/2 tsp. Vaseline oil;
• 1/4 tsp. boric acid.

After simple mixing, store the ointment in a cool, dark place. It should be applied to the affected areas of the skin before going to bed.

A herbal mixture of fresh burdock roots, grape leaves and flaxseeds is good for skin poultices. To make it, you need 1 tbsp. l. Place each of the components in a glass of boiling cow or goat milk. After simmering for ten minutes over low heat, the broth is cooled to a comfortable temperature and used as soon as possible.

Juniper baths help eliminate inflammatory processes in affected skin. The concentrate for them is obtained by boiling juniper berries for ten minutes in three times the volume of boiling water. The cooled broth should be cooled, filtered, poured into a glass container and stored in the refrigerator, adding as needed to the finished hot bath.

Treatment prognosis

In most cases, the prognosis for treatment is favorable. With a timely diagnosis and a correctly defined therapeutic strategy, complete remission is achieved with a small number of subsequent relapses, or even without them at all.

Delayed treatment can lead to the persistence of residual cosmetic defects on the skin - scars, healed erosions, age spots. Frequent damage to the elements of the rash is fraught with the development of secondary infections and trophic ulcers. Chronic atrophic acrodermatitis increases the risk of developing benign formations.

The prognosis of treatment for the enteropathic form is problematic. Zinc deficiency, which develops in infancy, is extremely dangerous for the child’s health, and in some cases, for his life. When a characteristic combination of skin and intestinal symptoms you must immediately contact a specialist.

Prevention

Despite the unsightly external manifestations, neither type of disease is contagious. Even a bacterial pathogen that causes atrophic form disease, requires the participation of ixodid ticks as an intermediate link for transmission. Thus, to prevent acrodermatitis, limiting social contacts is not required.

Children's forms of acrodermatitis have a very peculiar course. They can be tolerated either quite easily (Gianotti-Crosti syndrome) or extremely difficult (enteropathic variety). Symptoms are rarely limited to the extremities, quickly spreading to distant areas of the body - face, back, abdomen, buttocks. It may even damage the mucous membranes of the mouth and eyes. Elements of the rash easily form on the elastic skin of children, merge, collapse, form ulcers and erosions.

The borderline age is the period of puberty. When the child reaches 12–14 years of age, symptoms childlike pathologies, as a rule, undergo complete remission.

is a set of dermatological and concomitant reactions that occur in response to a viral infection in children. The syndrome manifests itself as a papular or papulovesicular rash on the skin of the face, buttocks, upper and lower limbs. Other symptoms of a viral infection may occur - lymphadenopathy, hepatosplenomegaly, etc. Making a diagnosis involves comparing physical examination data and the results of laboratory diagnostic methods. PCR and RIF make it possible to identify the causative virus. No specific treatment is required; Gianotti-Crosti syndrome tends to regress within a period of up to 8 weeks.

General information

Papular acrodermatitis in children, or Gianotti-Crosti syndrome, is a parainfectious disease that combines a nodular rash of typical localization, enlargement of regional lymph nodes, liver and spleen. Papular acrodermatitis was first described in 1955 by Italian dermatologists F. Gianotti and A. Crosti. In 1970, together with a group of pediatricians, Gianotti confirmed the infectious etiology of the disease, while considering it a characteristic manifestation of hepatitis B in children. Some time later, Caputo et al proved that acrodermatitis papularis is specific reaction child's body for infection, regardless of the type of virus. Thus, the concept of “Gianotti-Crosti syndrome” was introduced, which includes all papular and papulovesicular rashes provoked by a viral infection.

No genetic predisposition to this syndrome has been identified. It can appear in children from 6 months to 14 years, with an average age of 2 years. In rare cases, it occurs in adults. The male sex is more prone to the disease. The syndrome exhibits seasonality, falling in the autumn-winter period. In Italy and Japan main reason Gianotti-Crosti syndrome is caused by the hepatitis B virus, in North America– Epstein-Barr virus. In other countries, a mixed etiology of the disease is observed.

Causes of Gianotti-Crosti syndrome

Gianotti-Crosti syndrome is an immune response of a child's skin to a viral infection. The first stage of development is the dissemination of the virus in the child’s body upon first contact and its introduction into skin. When the infectious agent enters again, inflammation of the epidermis and blood capillaries occurs according to type IV hypersensitivity reaction according to Jell and Coombs. Gianotti-Crosti syndrome can be caused by hepatitis B virus, Epstein-Barr virus, cytomegalovirus, Coxsackie A-16 virus, enterovirus, adenovirus, influenza and parainfluenza viruses, rubella virus, type I and VI herpes viruses, HIV, parvovirus B19. Also, this syndrome can be provoked by immunization of a child with a vaccine against influenza, polio, MMR vaccine, BCG, etc. According to recent studies, the disease can be caused by β-hemolytic streptococcus, M. pneumoniae, N. meningitidis.

Histologically, there are no specific changes in the skin with Gianotti-Crosti syndrome in a child. The epidermis may have mild acanthosis, parakeratosis and spongiosis. Rarely, vasculitis and release of red blood cells into surrounding areas occurs. Immunochemical examination of tissues can establish the presence of CD4 and CD8 T lymphocytes.

Symptoms of Gianotti-Crosti syndrome

Gianotti-Crosti syndrome manifests itself as symmetrical, monomorphic and monochrome skin rash. Its main elements are papules or papulovesicles of dense consistency. Average diameter 1-5 mm. More often they have a pink, pale red or “copper” color, less often - flesh or purple. In areas of frequent trauma, the Koebner phenomenon may occur. On the elbows and knees, groups of papules can merge and form large plaques. Primary localization of the rash: face, buttocks, forearm and extensor surfaces of the lower extremities, rarely - the torso. An ascending sequence of the appearance of elements on the body is characteristic: from the lower extremities to the face.

The rash is often preceded by a low-grade fever. After 5-7 days from the onset of the disease, the rash spreads to adjacent areas. There are options without rashes on the face or buttocks. As a rule, the elements are not accompanied by any somatic sensations, only in some cases itching occurs. Skin manifestations of infection disappear on their own after 14-60 days.

Depending on the etiological factor other symptoms of a viral infection may develop: lymphadenopathy, hyperthermia, hepatomegaly, splenomegaly, erosion of the mucous membranes, rhinitis, pharyngitis and other diseases of the upper respiratory tract. The most common occurrence is enlarged lymph nodes. At the same time, they are painless, elastic, have a dense consistency, and are not fused to each other or to the surrounding tissues.

Diagnosis of Gianotti-Crosti syndrome

Diagnosis of Gianotti-Crosti syndrome consists of comparing anamnestic, clinical and laboratory data. When collecting anamnesis, the pediatrician is able to establish characteristic primary locations skin rashes, possible reasons infection. During the physical examination, symptoms specific to a particular viral infection may be detected. Laboratory diagnostic methods can detect monocytosis, lymphocytosis or lymphopenia in the CBC; a biochemical blood test reveals an increase in alkaline phosphatase, ALT, AST, rarely - an increase total bilirubin due to direct fraction. To exclude viral hepatitis B, ultrasound and liver biopsy, determination of anti-HBs, HBc, HBe markers in the blood can be performed. PCR and RIF make it possible to accurately identify the virus that provoked the development of Gianotti-Crosti syndrome.

In practical pediatrics, criteria are used that indicate the development of Gianotti-Crosti syndrome: characteristic elements of epidermal rashes; damage to 3 or 4 areas of the body: face, buttocks, forearms or extensor surfaces of the thigh and lower leg; symmetry of the lesion; duration of at least 10 days. If there are papules or papulovesicles on the body or their peeling, this syndrome is excluded. Differential diagnosis Gianotti-Crosti syndrome is carried out with infectious mononucleosis, licheniodes parapsoriasis, hemorrhagic vasculitis, lichen planus and septicemia. For this purpose, the child is consulted by a pediatric dermatologist and an infectious disease specialist.

Treatment of Gianotti-Crosti syndrome

Gianotti-Crosti syndrome does not require treatment specific treatment. After some time (from 14 days to 2 months), all manifestations disappear on their own, without the use of medications. The prognosis for recovery is favorable. Complications and relapses are not typical. Symptomatic therapy may include steroids local application, which do not contain fluoride (mometasone furoate, methylprednisolone aceponate), for the prevention of pustular complications and antihistamines (suprastin) to relieve itching. Constant monitoring by a pediatrician or family doctor is recommended. If infection with the hepatitis B virus is confirmed, hepatoprotectors (Essentiale) can be used. Immunomodulators are rarely used.