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Laterothoracic exanthem

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1999. Updated in September 2015. DermNet NZ Revision October 2021


Laterothoracic exanthem — codes and concepts
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What is laterothoracic exanthem?

Laterothoracic exanthem is an uncommon rash involving the sides of the trunk in young children.

Laterothoracic exanthem is also known as Asymmetric Periflexural Exanthem of Childhood (APEC). A new name has been proposed: superimposed lateralised exanthem of childhood (2014).

Who gets laterothoracic exanthem?

Laterothoracic exanthem affects twice as many girls as boys. The average age is two years; most cases are between one and five years of age.

What is the cause of laterothoracic exanthem?

Laterothoracic exanthem mainly occurs in winter and spring, as is common for viral infections. In occasional cases a specific virus has been associated with laterothoracic exanthem including adenovirus, parvovirus B19, Epstein-Barr virus, and most recently with SARS-CoV-2 (COVID-19). 

Following a case associated with adenovirus, the authors speculated that early postzygotic mutation has rendered the skin on one side of the body more reactive to an infective agent. Subsequent involvement of the other side of the body may reflect less reactive skin on that side.

What are the clinical features of laterothoracic exanthem

The rash is often mistaken for eczema (dermatitis) or a fungal infection (ringworm). It usually starts in the armpit or groin and gradually extends outwards, remaining predominantly on one side of the body. It may spread to the face, genitalia, hands, or feet.

Laterothoracic exanthem starts as tiny raised pink papules, which may be surrounded by a pale halo. These become flat and scaly over the next week or two. The middle of older patches fades to a dusky grey. Occasionally the patches are net-like or in rings. Little blisters or blood spots may occur. The rash is usually quite itchy.

Sometimes other features of viral infection occur at the onset of the rash, such as a fever, sore throat, cold, vomiting, and/or diarrhoea. The lymph glands in the armpits and groins may be enlarged.

Laterothoracic exanthem

How is laterothoracic exanthem diagnosed?

Laterothoracic exanthem is a clinical diagnosis and although investigations are not usually required they may include:

  • Blood tests including viral serology
  • Skin biopsy - nonspecific perivascular lymphocytic infiltrate.

What is the treatment of laterothoracic exanthem?

There is no specific treatment for laterothoracic exanthem. The itching can be relieved with:

What is the outcome for laterothoracic exanthem?

The rash lasts for several weeks, but always resolves without treatment within three months.

 

Bibliography

  • Duarte AF, Cruz MJ, Baudrier T, Mota A, Azevedo F. Unilateral laterothoracic exanthem and primary Epstein-Barr virus infection: case report. Pediatr Infect Dis J. 2009;28(6):549–50. doi:10.1097/INF.0b013e318193eca7. Journal 
  • Glick LR, Fogel AL, Ramachandran S, Barakat LA. Unilateral laterothoracic exanthem in association with coronavirus disease 2019. JAAD Case Rep. 2020;6(9):900–1. doi:10.1016/j.jdcr.2020.07.020. PubMed Central 
  • Niedermeier A, Pfützner W, Ruzicka T, Thomas P, Happle R. Superimposed lateralized exanthem of childhood: report of a case related to adenovirus infection. Clin Exp Dermatol. 2014 Apr;39(3):351–3. doi: 10.1111/ced.12311. PubMed PMID: 24635078.

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