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Atypical exanthems in children

Robert Sidbury, MD, MPH
Section Editor
Moise L Levy, MD
Deputy Editor
Rosamaria Corona, MD, DSc


An "atypical exanthem" is an acute skin eruption that differs in appearance from classically described viral rashes such as measles, rubella, or erythema infectiosum. They are usually preceded or associated with nonspecific systemic symptoms, including low-grade fever, malaise, or upper respiratory or gastrointestinal tract infection.

Atypical exanthems are a common cause of pediatric urgent care visits. The most frequent cause is a viral infection, followed by drug reactions, and bacterial infections [1,2].

This section will review three uncommon diseases that present with an atypical rash: unilateral laterothoracic exanthem; coxsackievirus A6 hand, foot, and mouth syndrome; and papular-purpuric gloves and socks syndrome. Gianotti-Crosti syndrome, a papular eruption of childhood with acral distribution associated with viral infections is discussed separately [3]. (See "Gianotti-Crosti syndrome (papular acrodermatitis)".)


Unilateral laterothoracic exanthem (ULE), also known as asymmetric periflexural exanthem of childhood, is a distinctive skin eruption that usually begins on one side of the trunk and then generalizes [4]. It typically affects children between one and five years of age, but has been also reported in adults [5-8].

ULE occurs year round, with a peak during spring. The cause is unknown. Indirect evidence, such as patients' age, occurrence of small epidemics, seasonal distribution, association with upper respiratory tract infections, and spontaneous resolution, suggests a viral etiology. However, microbiologic studies on throat, stool, blood, and skin samples from affected children have not identified a specific etiologic agent [9-11].

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Literature review current through: Oct 2017. | This topic last updated: Jun 27, 2017.
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