Asymmetric Periflexural Exanthem Research Articles

Asymmetrical Periflexural Exanthem Associated with SARS-CoV-2 Infection in a Paediatric Patient.

Abstract is missing (Short communication)

An asymmetric morbilliform eruption in an adult male

An asymmetric morbilliform eruption in an adult male

Asymmetric Periflexural Exanthem in an Adult Patient After Pfizer-BioNTech COVID-19 Vaccine.

Asymmetric Periflexural Exanthem in an Adult Patient After Pfizer-BioNTech COVID-19 Vaccine.

Asymmetric periflexural exanthem of childhood and influenza virus infection.

Asymmetric periflexural exanthem of childhood (APEC) is a self-limited disease characterized by unilateral exanthem. The etiology is unknown, but a viral agent is suspected. Most often there is no formal proof of an associated viral etiology, but several associations between APEC and some viruses have been described. We report a 2-year-old girl with APEC associated with influenza A. This case allows us to provide an additional argument on a probable viral etiology of APEC and a possible etiologic role of influenza A.

Unilateral Mediothoracic Exanthem: Case Reports of two Indian Female Children

Abstract Unilateral mediothoracic exanthem is a variant of a common entity in Western literature, namely Asymmetric Periflexural Exanthem of Childhood (APEC). Less than ten cases of unilateral mediothoracic exanthem have been described worldwide, and only two are reported in Indian literature. Herein, we report two childhood cases of uni-lateral mediothoracic exanthem from India. Dermatologists must be aware of this self-limiting condition, in order to avoid invasive and exhaustive investigations and misdiagnosis.

Unilateral Laterothoracic Exanthem – Asymmetric Periflexural Exanthem of Childhood – a Case Report and Literature Review

AbstractUnilateral laterothoracic exanthem (ULE), or asymmetric periflexural exanthem of childhood (APEC), is an uncommon skin eruption that usually occurs in childhood, with unilateral distribution and self limiting course. The etiology of ULE is unknown, but viral cause is suspected. We report a case of ULE in a 4-year-old girl, that was associated with parvo virus B19 infection, and a brief selected literature review. The patient presented with unilateral maculopapular rash on the left side of the body which was asymptomatic and resolved spontaneously within 5 weeks. The clinical diagnosis of ULE may be precise, ruling out a broad spectrum of differential diagnosis, and prevent unnecessary examinations, whereas the patient is informed about the benign self-limiting nature of ULE.

Pityriasis Rosea, Gianotti-Crosti Syndrome, Asymmetric Periflexural Exanthem, Papular-Purpuric Gloves and Socks Syndrome, Eruptive Pseudoangiomatosis, and Eruptive Hypomelanosis: Do Their Epidemiological Data Substantiate Infectious Etiologies?

Many clinical and laboratory-based studies have been reported for skin rashes which may be due to viral infections, namely pityriasis rosea (PR), Gianotti-Crosti syndrome (GCS), asymmetric periflexural exanthem/unilateral laterothoracic exanthem (APE/ULE), papular-purpuric gloves and socks syndrome (PPGSS), and eruptive pseudo-angiomatosis (EP). Eruptive hypomelanosis (EH) is a newly discovered paraviral rash. Novel tools are now available to investigate the epidemiology of these rashes. To retrieve epidemiological data of these exanthema and analyze whether such substantiates or refutes infectious etiologies. We searched for articles published over the last 60 years and indexed by PubMed database. We then analyzed them for universality, demography, concurrent patients, temporal and spatial-temporal clustering, mini-epidemics, epidemics, and other clinical and geographical associations. Based on our criteria, we selected 55, 60, 29, 36, 20, and 4 articles for PR, GCS, APE/ULE, PPGSS, EP, and EH respectively. Universality or multiple-continental reports are found for all exanthema except EH. The ages of patients are compatible with infectious causes for PR, GCS, APE/ULE, and EH. Concurrent patients are reported for all. Significant patient clustering is demonstrated for PR and GCS. Mini-epidemics and epidemics have been reported for GCS, EP, and EH. The current epidemiological data supports, to a moderate extent, that PR, GCS, and APE could be caused by infectious agents. Support for PPGSS is marginal. Epidemiological evidences for infectious origins for EP and EH are inadequate. There might be growing epidemiological evidence to substantiate or to refute our findings in the future.

Superimposed lateralized exanthem of childhood: report of a case related to adenovirus infection

A 6-year-old boy developed a unilateral itchy rash, which was followed by a less severe bilateral involvement. The lesions resolved spontaneously within 4 weeks. Apparently, the rash was triggered by an adenovirus infection of the respiratory tract. Terms used currently for this disorder include 'unilateral laterothoracic exanthem' or 'asymmetrical periflexural exanthem of childhood'. The recently proposed term 'superimposed lateralized exanthem of childhood' implies the new concept that an early postzygotic mutation has rendered the skin on one side of the body more reactive to infective agents. The subsequent bilateral involvement would reflect a less severe reactivity of the contralateral keratinocytes.

Unilateral laterothoracic exanthem in a pregnant woman – case report

Unilateral laterothoracic exanthem (ULE) (also termed asymmetric periflexural exanthem of childhood APEC) has been linked to viral infection, in particular parvovirus B-19, citomegalovirus and Ebstein Barr virus. Its prevalence is higher during spring and winter, most published reports involve white people. The diagnosis is clinical, the virusological tests, in most of the cases, are negative. The exanthem is self-limited, it resolves in four-six weeks, it requires only symptomatic treatment. Our case is particular by the appearance in a pregnant woman to whom we have not succed to identify any virus involved, with wonderful clinical results under no medication. We follow the evolution of the pregnancy.

Superimposed lateralized exanthema of childhood: a proposed explanation for an enigmatic disorder

ejd.2012.1715 Auteur(s) : Rudolf Happle1 rudolf.happle@uniklinik-freiburg.de, Ana I Nunez-Giralda2 1 Department of Dermatology, Freiburg University Medical Center, Hauptstr. 7, 79104 Freiburg, Germany 2 Pediatric Outpatient Clinic, Centro de Salud Guayaba, Madrid, Spain Lateralized forms of exanthema occurring in children represent a perplexing group of disorders that have been described under the names “asymmetric periflexural exanthem of childhood” [1] or “unilateral laterothoracic exanthema” [...]

Gianotti-Crosti Syndrome, Pityriasis Rosea, Asymmetrical Periflexural Exanthem, Unilateral Mediothoracic Exanthem, Eruptive Pseudoangiomatosis and Papular-Purpuric Gloves and Socks Syndrome: A Brief Review and Arguments for Diagnostic Criteria

Several exanthems including Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, eruptive pseudoangiomatosis, and papular-purpuric gloves and socks syndrome are suspected to be caused by viruses. These viruses are potentially dangerous. Gianotti-Crosti syndrome is related to hepatitis B virus infection which is the commonest cause of hepatocellular carcinoma, and Epstein-Barr virus infection which is related to nasopharyngeal carcinoma. Pityriasis rosea has been suspected to be related to human herpesvirus 7 and 8 infections, with the significance of the former still largely unknown, and the latter being a known cause of Kaposi's sarcoma. Papular-purpuric gloves and socks syndrome is significantly associated with human B19 erythrovirus infection which can lead to aplastic anemia in individuals with congenital hemoglobinopathies, and when transmitted to pregnant women, can cause spontaneous abortions and congenital anomalies. With viral DNA sequence detection technologies, false positive results are common. We can no longer apply Koch's postulates to establish cause-effect relationships. Biological properties of some viruses including lifelong latent infection, asymptomatic shedding, and endogenous reactivation render virological results on various body tissues difficult to interpret. We might not be able to confirm or refute viral causes for these rashes in the near future. Owing to the relatively small number of patients, virological and epidemiology studies, and treatment trials usually recruit few study and control subjects. This leads to low statistical powers and thus results have little clinical significance. Moreover, studies with few patients are less likely to be accepted by mainstream dermatology journals, leading to publication bias. Aggregation of data by meta-analyses on many studies each with a small number of patients can theoretically elevate the power of the results. Techniques are also in place to compensate for publication bias. However, these are not currently feasible owing to different inclusion and exclusion criteria in clinical studies and treatment trials. The diagnoses of these rashes are based on clinical assessment. Investigations only serve to exclude important differential diagnoses. A wide spectrum of clinical features is seen, and clinical features can vary across different populations. The terminologies used to define these rashes are confusing, and even more so are the atypical forms and variants. Previously reported virological and epidemiological results for these rashes are conflicting in many aspects. The cause of such incongruence is unknown, but low homogeneity during diagnosis and subject recruitment might be one of the factors leading to these incongruent results. The establishment and proper validation of diagnostic criteria will facilitate clinical diagnosis, hasten recruitment into clinical studies, and allow results of different studies to be directly compared with each another. Meta-analyses and systematic reviews would be more valid. Diagnostic criteria also streamline clinical audits and surveillance of these diseases from community perspectives. However, over-dependence on diagnostic criteria in the face of conflicting clinical features is a potential pitfall. Clinical acumen and the experience of the clinicians cannot be replaced by diagnostic criteria. Diagnostic criteria should be validated and re-validated in response to the ever-changing manifestations of these intriguing rashes. We advocate the establishment and validation of diagnostic criteria of these rashes. We also encourage the ongoing conduction of studies with a small number of patients. However, for a wider purpose, these studies should recruit homogenous patient groups with a view towards future data aggregation.

Asymmetrical periflexural exanthem of childhood with concurrence of molluscum contagiosum infection

Asymmetrical periflexural exanthem of childhood with concurrence of molluscum contagiosum infection

Transient Linear Eruption: Asymmetric Periflexural Exanthem or Blaschkitis

We report the case of a 4-year-old boy who presented with a transient extensive eczematous eruption on the left side of his trunk and extremities, with clear demarcation in the midline. The eruption started to resolve without any sequelae in 4 weeks. The history and clinical findings suggest that this transient eruption could have been either a case of unilateral blaschkitis in childhood or asymmetric periflexural exanthem.

Asymmetrical periflexural exanthem exhibiting pseudoisomorphic Köebner response in an adult

Asymmetrical periflexural exanthem is a rare clinical condition, seen almost exclusively in children. Very few adult cases have been reported in the literature. We report a case of this rare eruption in an adult man showing characteristic clinical and histological features. Interestingly, this patient also exhibited a pseudoisomorphic Köebner response. Although an infective aetiology of viral origin has been suggested for this localized eruption, the aetiology remains unknown. We are of the opinion that the pseudoisomorphic Köebner response in this patient may support the inoculation hypothesis in the pathogenesis of this disorder.

Asymmetric periflexural exanthem of childhood: report of two cases with parvovirus B19

Asymmetric periflexural exanthem of childhood: report of two cases with parvovirus B₁₉

Asymmetric periflexural exanthem of childhood in an adult patient with parvovirus B19

Asymmetric periflexural exanthem of childhood in an adult patient with parvovirus B19

Asymmetric periflexural exanthem of childhood in an adult patient with parvovirus B19

Asymmetric periflexural exanthem of childhood in an adult patient with parvovirus B19

Asymmetric periflexural exanthem of childhood: Who are you?

Asymmetric periflexural exanthem of childhood: Who are you?

Asymmetric periflexural exanthem of childhood: microbiologic case-control study.

Our objective was to study possible etiologic factors of asymmetric periflexural exanthem of childhood (APEC) among a large panel of microbiologic agents not yet investigated. To do so, we designed a prospective case-control study using throat, stool, blood, and skin samples, and enlisted 37 children with APEC and 37 age-matched controls without eruption seen consecutively from February 1995 to April 1996 from a mixed referral center and community-based population. No interventions were done. Used as the main outcome measure was the differences in the two groups for microbiologic investigations. No significant statistical differences between cases and controls for virus and bacteria investigated were found. No microorganism was identified as a possible etiologic agent in any of the APEC patients. APEC is not a nonspecific cutaneous eruptive pattern to several common microbiologic agents. More sophisticated molecular approaches are needed to address its etiology.

Asymmetric periflexural exanthem of childhood: a clinical, pathologic, and epidemiologic prospective study.

To assess the clinical, pathologic, and epidemiologic features of asymmetric periflexural exanthem of childhood (APEC), a clinically distinctive eruption, especially its link with pityriasis rosea and pattern of transmission. A prospective case series, including an analysis of epidemiologic triggering factors and mode of transmission. Pathologic study, including immunohistochemistry of the inflammatory infiltrate. A mixed, community-based referral center. A total of 37 girls and 30 boys with typical APEC referred from April 1994 to December 1996 were included in the study; 82% came from the greater Bordeaux area in France. None. Possible interhuman transmission of APEC. [corrected] No triggering factor was identified; no interhuman transmission occurred; and no demonstrable link with pityriasis rosea was apparent. Several new clinical variants were recognized or confirmed (high fever, facial and peripheral involvement, prolonged course). Distinctive perisudoral interface CD8+ infiltrate was suggestive of diagnosis. Interhuman transmission was doubtful, but inoculation disorder was still possible. Histopathologic findings seem more specific than previously thought.