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Paediatricians and dermatologists in the Aquitaine region of France were informed of the clinical features of asymmetric periflexural exanthem of childhood (APEC) and asked to report cases to paediatric dermatologists in Bordeaux (Didier Coustou and colleagues. Archives of Dermatology 1999;135:799–803). They came up with 67 cases (37 girls) between April 1994 and December 1996.
The condition affected mainly toddlers (mean age 28 months, range 1–5 years). Peak onset was in September, 90% of cases presenting between February and September. There were no cases in relatives or contacts. There was an erythematous rash consisting of convergent micropapules and starting usually on one side of the trunk near the axilla but later spreading centrifugally. Both sides of the body were eventually involved in 70% of cases. A prodrome involving the upper respiratory or gastrointestinal tracts was noted in 60% and fever in 40%. Itching (65%) and lymphadenopathy (70%) were common. The rash lasted typically for two or three weeks but it persisted for seven weeks or more in eight children. Skin biopsy specimens in nine cases had infiltration with T lymphocytes predominantly around sweat glands.
APEC, which is said to have been described first in 1962, appears to be a specific and fairly common childhood exanthem. Its cause is unknown but infection seems probable.