Author: Kevin Zheng, Medical Student, University of Auckland. Chief Editor: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, October 2015.
Papular purpuric gloves and socks syndrome is a distinctive viral rash characterised by painful redness and swelling of the feet and hands. It is sometimes abbreviated PPGSS.
Papular purpuric gloves and socks syndrome is usually caused by an erythrovirus, EVB19 or Parvovirus B19. This is a single-stranded DNA virus that targets red cells in the bone marrow. It spreads via respiratory droplets, and has an incubation period of 7–10 days.
The syndrome has also been noted to have seasonal variation, often occurring during spring and summer. Papular purpuric gloves and socks syndrome has also been associated with:
Papular purpuric gloves and socks syndrome typically occurs in young adults. It also sometimes affects older adults and children.
The prodromal phase of parvovirus B19 infection causes nonspecific viral symptoms such as mild fever, headache and arthralgia.
Papular purpuric gloves and socks syndrome is rapidly progressive, presenting as symmetrical, painful erythema and oedema of the feet and hands.
Enlarged lymph nodes are common. Neurological symptoms may also occur.
Although the rash itself does not have long-term sequelae, erythrovirus B19 infection can result in complications. These include:
In most cases, papular purpuric gloves and socks syndrome is a clinical diagnosis based on its characteristic features of a sharp cut-off at the wrists and ankles and rapidly progressing course. Parvovirus can cause other rashes such as erythema infectiosum. The diagnosis can be confirmed by blood tests.
If the patient is unwell, or has haemolytic anaemia, a full blood count should be performed. Ultrasound examination and Doppler examination of at-risk pregancies can detect hydrops fetalis.
Routine laboratory tests are usually normal. Some patients may have lymphopaenia, neutropaenia, or thrombocytopenia. A skin biopsy is not indicated for the diagnosis of papular purpuric gloves and socks syndrome, as histopathologic findings are nonspecific.
Treatment of papular purpuric gloves and socks syndrome is generally symptomatic. Affected children/adults may remain at school/work if they feel well enough, as the infectious stage of viraemia occurs before the rash is evident. Resolution of symptoms usually occurs within one to three weeks without scarring.
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