Left-Sided Eruption on a Child: Case Study

Vanessa Lichon, MD, CWS; Amor Khachemoune, MD, CWS


Dermatology Nursing. 2007;19(4):366-367. 

In This Article


This patient has asymmetric periflexural exanthema of childhood (APEC), a diagnosis made clinically based on the individual's presentation. Originally described by Brunner, Rubin, and Dunlap (1962) as "a new papular erythema of childhood," APEC has been described in the literature by a few names, including unilateral laterothoracic exanthema (Bodemer & de Prost, 1992), localized erythema with regional lymphadenopathy (TaEFeb et al., 1986), and lichen miliaris (Laur, 1993). Finally, TaEFeb, ME9graud, Legrain, Mortureux, and Maleville (1993) suggested the acronym "APEC" that stands today.

The clinical presentation of a unilateral, asymmetric erythematous papular and macular eruption originating near the axilla or other flexures and spreading centrifugally over a few weeks in a child with a viral-like prodrome is diagnostic for APEC (Coustou, Leaute-Labreze, Bioulac-Sage, Labbe, & TaEFeb, 1999; Khachemoune, Lockshin, & El-Gamal, 2005; Khachemoune, 2006). The exact cause of APEC is un known, but most evidence suggests a viral origin (Coustou et al., 1999; McCuaig et al., 1996). In a study by Coustou and colleagues in 1999, 61% of the cases the authors examined had a period of prodrome, including rhinitis, pharyngitis, otitis, or fever. There are at least three reported cases of individuals with APEC and parvovirus B19; two of them were children (GuimerE1-MartEDn-Neda et al., 2006) and one was an adult (Pauluzzi, Festini, & Gelmetti, 2001). There are also some reports of APEC in association with axonal Guillain-BarrE9 syndrome (Auvin et al., 2004) and acute lymphoblastic leukemia (Fort & Greer, 1998). While the exact cause re mains unknown, there is no evidence that APEC is contagious.


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