This is reposted with permission on behalf of Laurie Good, who blogs at www.goodhappenings.com
Most of you know I graduated from medical school and am currently doing dermatology research in Colorado. Some of you might also remember a post I wrote about a year ago about one of Jackie’s skin conditions, called ACROPUSUTULOSIS (aka infantile acropustulosis, acropustulosis of childhood, or acromelanosis). I was shocked by how many people wrote in to say their child has this disease as well, supporting my belief that acropustulosis LARGELY under-diagnosed or misdiagnosed in internationally adopted kids. My belief is that, while considered “rare,” it is actually quite prevalent in the population of internationally adopted pediatric patients.
There is an association between scabies and acropustulosis, but the no one has any idea what percentage of kids who had scabies might go on to have acropustulosis. Acropustulosis is a condition of childhood, as most cases are thought to resolve around 2-3 years of age (though Jack’s is still raging strong at 3+ years old). It usually manifests as recurrent pustular (blister) outbreaks around the hands and feet in kids who were previously infected with scabies. These blisters ITCH, crop up in groups, last a week or 2, then resolve. A few weeks or months later, new ones appear just like the previous batch, but in most cases the outbreaks get progressively less severe until the recurrences stop altogether. Here are a few photos of Jack’s most recent flare, which was fairly mild by the time I took pictures”¦his typical pattern is palms, between his fingers, and soles of his feet, but he also gets them on his ankles, dorsal hands (shown below), and dorsum of feet too:
In the picture below, you can see the itch is so intense he occassionally scratches until he bleeds:
I know many adoptive parents have bounced from doctor to doctor trying to get a diagnosis and find an effective treatment for their child’s pustular outbreaks, which are admittedly tough to treat even when you have the proper diagnosis. Many of your kids have also 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 or its incidence. My interest is in highlighting, again, the connection between scabies and acropustulosis and investigating the incidence of acropustulosis in children who have had a previous scabies infection. 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 children who were adopted from overseas. International adoption has become much more commonplace, with 15-20,000 kids per year adopted into the US. If this disease is afflicting our children, it is something about which their doctors need to be better educated.
To that end, I am writing a case series on adopted children with acropustulosis following 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
I would be grateful for your participation on so many levels, both personal and medical. 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 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.
4 Responses
when we brought our daughter home a little over a year ago (along with ten other families who adopted children from the same orphanage), she had these skin issues. all of the kids from her orphanage had these skin issues. guess what cleared up our daughter’s skin? breastmilk.
i started preparing to breastfeed my daughter long before i brought her home. unfortunately, i got frustrated, and wasn’t producing much milk. about three months before heading to vietnam, a friend’s sister offered us A LOT of her frozen breastmilk. she had stopped breastfeeding and had stored up her extra milk in her freezer. we took it without hesitation, and started giving it to our daughter the day we came home.
our daughter’s skin issues got better, and cleared up, way before the other children who came home at the same time as her….i believe this was due to her daily bottles of breastmilk. i know not everyone has friends who can hand over cases of breastmilk…..so look up your local milk bank, or not so local milk bank (some places ship), you may be able to get some donated to your child.
i’ve been wanting to share this information with adoptive families for a long time. thanks for giving me the opportunity to do so.
this may not be the answer, or work, for all children…but it can’t hurt, right?
Since you are studying disorders of the skin, I would like to bounce a problem off you. I have some unknown parasite of the skin. It looks like a thread worm and travels through the lymphatic system and exits sometimes through the skin. It has an attraction to hair which it then drills a hole in the scalp to live. You can see the white colored thread like multi length (worm ?) with a 10X mirror. The parasite burns when disturbed and causes the skin to turn a purple red colour for a few minutes. They lay a white egg on the hair but it is not attached to the hair. I have open sores on my face from which I can remove the parasite while the open sore releases a yellow to orange slime. The skin can heal over the sore without any healing between the base of the sore and the level of the skin. My main problem is that this condition does not exist. I went to a dermatologist who refused to look at my skin as he “was positive there never has been a case of parasites living in the skin”. I got my money’s worth from him.
So far I have learned to shut up and deny this is happening. My husband told the physician he has seen them too and they told him he hallucinated it “out of love”. He got the love right.
I am scared. I am so afraid, I took the medication for the parasites and they were sluggish for a few days and I had a horrific headache.
I can not even find any treatment for this condition. I have enough samples to supply a few labs but no one to order the test. I will submit to group therapy 25 psychiatrists and me because I frankly would prefer to be crazy than to have my brain digested prior to my demise. Any suggestions?
I tried to fill out the acropustulosis questionnaire but if your child was not d/x with scabies at home, you cannot complete it. It should enable you skip that section. My child only had infantile acropustulosis. She may have had scabies earlier at the orphanage but I can’t say for sure. At any rate, I cannot complete your form.
I have a little different problem. I moved to Cambodia a little over a year ago and I have been volunteering in an orphanage with 74 children here. It is an extremely poor orphanage and the children are in really bad shape. The 10 babies all have scabies and head lice. The 3 – 5 year olds I believe have infantile acropustulosis. I have been trying desperately to help these children. I think they just keep getting reinfected because it is impossible to clean their orphanage. Do you have any ideas how I can help these children????