I was on my GP post in my final year of medicine when I saw a 3 year old boy come in with his mother for a simple seasonal upper respiratory tract infection. You know how children are, they get ill 12 times a year on average, yet nothing stops worrying mothers from… well… worrying.
Well, on this occasion, I asked “Is there anything else, his chest is clear and so is the back of his mouth”, and oh boy am I glad I asked this question! To my surprise she said:
“Yes, well he has a new rash on both of his elbows and he’s had it for a week, I’ve applied hydrocortisone to it and it isn’t helping..”
In the field of dermatology, healthcare providers frequently encounter a myriad of skin conditions, each with its unique characteristics and diagnostic challenges. Gianotti-Crosti Syndrome (GCS), also known as papular acrodermatitis of childhood, is one such condition that occasionally puzzles even experienced clinicians, it certainly puzzled me.
His rash looked something like the above, except in a smaller cluster and flesh-coloured. At first I said:
“Oh that might be milia”
… Well I inspected the other elbow and it was more like the picture above, with some areas of excoriation. Firstly, I am really annoyed at myself for not properly inspecting all of his skin, but I can’t blame myself because I’m only a medical student and I was doing a respiratory examination. This being said, food for thought for future examinations. Secondly, why did I think it was milia?! I had the diagnosis completely wrong. For reference, milia does not look like GCS, it’s pearly and white, not flesh coloured.
Come to think of it, I had seen this rash before, on my younger sister when she was 8. We were going swimming together and I had just conceived verruca warts on the soles of my feet, and my sister had a similar flesh-coloured lesion on her knees. At the time, we passed it off as HPV verrucas but just on her knees, and only today have I realised we were wrong.
After she left the room, I did an extensive google search and I found GCS, which despite the complicated name, is really common, affects children aged 1-9 and.. disappears on its own without any treatment. In fact, steroids do not help at all.
“Sorry security! Sorry, can you please just phone that mother back up.. I’ve asked her to keep applying steroids and I didn’t know what rash her son had, I need to speak to her”
Three missed phone calls later, I successfully contacted her and told her to leave the rash alone as it is self-resolving in 4-6 weeks. Gianotti-Crosti Syndrome is a unique dermatological condition that primarily affects young children and often resolves without specific intervention. Although its clinical presentation may resemble other skin disorders, an accurate diagnosis can be made through careful examination and consideration of the patient’s medical history, if only I knew it was linked to viral infections I would have made the connection sooner!
In conclusion:
The exact cause of Gianotti-Crosti Syndrome is not completely understood, but it is believed to be related to viral infections, particularly Epstein-Barr virus, hepatitis B virus, and cytomegalovirus. This syndrome is thought to represent an exuberant immune response to these infections. However, it is essential to note that not all cases are associated with viral infections, and idiopathic cases also occur. I do encourage you guys to google more images of this, as presentation can vary… but as a general rule of thumb, be on the look out if the child has had a recent illness from school and a papular skin-coloured rash suddenly appears. It’s certainly on my radar now!
skinzar 
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