Acropustulosis of infancy (also called infantile acropustulosis) is an itchy, pustular eruption characterized by recurrent crops of vesiculopustules on the palms and soles and is more common in African-American children.

Acropustulosis of infancy (AI) remits spontaneously.

AI is idiopathic.

Sometimes reported to be precipitated by a scabies infestation.

Lesions begin as pink papules that evolve into slightly larger tense pustules that spontaneously rupture leaving behind a collarette of thin scale (Fig. 2.25).

Lesions appear in crops, predominantly on the palms and soles but can also be seen on the dorsal and lateral aspects of the hands, wrists, and feet and last for 1 to 2 weeks.

Flares occur every couple of weeks to every couple of months.

Occasionally the legs, forearms, and scalp are also involved.

Lesions are intensely itchy.

Over time, flares become less frequent and less severe.

The condition eventually burns out within 2 to 3 years but it can remain uncomfortable until then.

Diagnosis is based on recognition of the characteristic clinical course and appearance of lesions and the ruling out of scabies.

A smear of pustule contents will show numerous neutrophils and some eosinophils.

A Gram stain, KOH, and Tzanck smear will be negative for organisms.