Infantile acropustulosis in internationally adopted children

Infantile acropustulosis (IA) is a recurrent, self-limited, vesicopustular disorder affecting young children. Most cases occur after scabies infestation. IA seems to be common in children adopted from orphanages overseas.

We sought to demonstrate the prevalence of IA in internationally adopted children and to examine the number of doctors seen for IA before a diagnosis, the frequency of misdiagnoses, specialists most likely to make the diagnosis of IA, and features of IA.

An Internet-based survey was posted on international adoption forums. Parent participation was voluntary, and specific inclusion criteria existed. Follow-up telephone questionnaire was then conducted.

Seventeen children had been given a diagnosis of IA and 21 had classic presentations but no IA diagnosis. Birth countries included Vietnam, China, Ethiopia, Guatemala, and Russia. Pediatric dermatologists and pediatricians affiliated with international adoption clinics were most likely to diagnose IA; 53% of diagnoses occurred after patient prompting. Frequent misdiagnoses were recurrent scabies and hand-foot-mouth disease. Feet were affected in 100% of cases and hands in 94%. Over 50% of children in both the diagnosed and undiagnosed groups had coexistent atopic dermatitis.

Limitations are potential parent reporting bias, selection bias, recall bias, and low response rate. Electronic survey instrument requires technically savvy parents.

IA appears to be common in internationally adopted children, who spent early childhood in crowded, unclean living conditions with a high prevalence of scabies infestation. IA is frequently misdiagnosed as recurrent scabies, resulting in unnecessary use of permethrin. This study demonstrated a coexistence of atopic dermatitis in over 50% of IA cases.