Asymmetric periflexural exanthema

Brunner 1962, Bodemer and de Prost 1992, Taieb 1993.

Unilateral laterothoracic exanthema, ULE, asymmetrical exanthema, asymmetrical periflexural exanthema of childhood, APEC.

Self-limiting, 4-6 weeks lasting, probably infectious allergic skin disease of childhood.

• Very rare occurrence
• Highest incidence in the 2nd-3rd year of life, but occurrence of the disease is also possible at the age of 10 years. Only a few adult cases have been recorded
• Girls are more frequently affected than boys
• Seasonal clustering in the spring and summer months
• occasionally occurring in smaller epidemics

The triggering agent has not yet been described.

There is a good general condition. After a mild catarrhal stage with upper respiratory tract infection or gastrointestinal symptoms, exanthema develops. Lens-sized, scarlitiniform, partly lichenoid and confluent, erythematous, discretely scaling papules occur mostly axillary, rarely also inguinal partly along the Blaschko lines. The efflorescences are mostly unilaterally accentuated or exclusively unilaterally arranged. After 2 weeks, the efflorescence spreads to the thoracic wall or leg and to the contralateral side. Regional lymphadenopathy must be expected.

• clinic
• Lab is non-specific
• Because pathogen is unknown, detection is not possible

Initially unilateral thoracoaxillary, in some cases also inguinal. Eventually spreading to the contralateral half of the body. Symmetrical occurrence is also possible from the beginning in a few cases.

Decent spongiosis, exocytosis, superficial perivascular lymphocytic dermatitis, otherwise nonspecific.

• Self-limiting course
• The exanthema is regressive after 3 weeks and usually healed after 4-6 weeks

1. Taïeb A, Mégraud F, Legrain V, Mortureux P, Maleville J. Asymmetric periflexural exanthem of childhood. Journal of the American Academy of Dermatology 1993;29:391-3.
2. Al Yousef Ali A, Farhi D, De Maricourt S, Dupin N. Asymmetric periflexural exanthema associated with HHV7 infection. Eur J Dermatol 2010;20:230-1.
3. Arun B, Salim A. Transient linear eruption: asymmetric periflexural exanthem or blaschkitis. Pediatr Dermatol 2010;27:301-2.
4. Drago F, Ciccarese G, Rebora A. Unilateral laterothoracic or asymmetric periflexural exanthem: is time to change the name of the disease? Clin Exp Dermatol 2015;40:570.
5. Harangi F, Varszegi D, Szucs G. Asymmetric periflexural exanthem of childhood and viral examinations. Pediatr Dermatol 1995;12:112-5.