Papular purpuric gloves and socks syndrome

Overview

Papular purpuric gloves and socks syndrome (PPGSS) is a rare, self-limiting dermatological condition most commonly caused by viral infections. It is characterized by a distinctive rash that primarily affects the hands and feet, appearing in a "gloves and socks" distribution pattern. The rash is typically symmetrical and includes red or purplish papules, petechiae, and edema, often accompanied by pain or pruritus. PPGSS is most frequently associated with parvovirus B19, but other viral agents have also been implicated. The syndrome affects both children and adults and is often accompanied by systemic symptoms such as fever, malaise, and lymphadenopathy. While visually striking and sometimes uncomfortable, PPGSS generally resolves spontaneously within one to two weeks without long-term consequences.

Causes

The primary cause of PPGSS is viral infection, with parvovirus B19 being the most common culprit. Other viruses known to trigger the syndrome include:

• Coxsackievirus

• Epstein–Barr virus (EBV)

• Cytomegalovirus (CMV)

• Human herpesvirus 6 (HHV-6)

• Hepatitis B virus

• Measles and rubella viruses

• HIV (rarely)

PPGSS is believed to result from an immune response to viral antigens, which leads to inflammation of the small blood vessels in the skin (vasculitis). This vascular inflammation causes leakage of blood into the skin, resulting in purpura and petechiae.

Symptoms

The hallmark symptoms of PPGSS involve both dermatologic and systemic manifestations. The rash has a sudden onset and is typically preceded or accompanied by viral-like symptoms.

Dermatological Features

• Symmetrical rash: Involves hands and feet in a "glove and sock" distribution pattern.

• Papules and petechiae: Red to purplish spots that may merge to form larger patches of purpura.

• Edema: Swelling of the hands and feet is common.

• Pain or itching: The rash may be painful, pruritic, or cause a burning sensation.

• Desquamation: In some cases, the skin may peel during the healing process.

Systemic Features

• Fever

• Malaise and fatigue

• Headache and sore throat

• Lymphadenopathy: Swollen lymph nodes, particularly in the cervical region.

• Myalgia or arthralgia: Muscle and joint pain may be present.

Diagnosis

Diagnosis of PPGSS is primarily clinical, based on the characteristic rash pattern and recent history of viral symptoms. Supporting diagnostic tools may include:

• History and physical exam: Identification of glove-and-sock patterned rash and accompanying viral symptoms.

• Serological tests: Testing for parvovirus B19 IgM and IgG antibodies can confirm recent infection. Other viral serologies may be considered based on clinical context.

• Complete blood count (CBC): May show mild leukopenia or anemia.

• Skin biopsy (rare): Performed in atypical cases to rule out other forms of vasculitis; histology shows perivascular lymphocytic infiltrates and red blood cell extravasation.

Treatment

There is no specific treatment for PPGSS, as the condition is self-limited and resolves on its own. Management focuses on symptomatic relief:

• Antihistamines: For relief of itching and allergic symptoms.

• Analgesics and antipyretics: Acetaminophen or ibuprofen can reduce fever, discomfort, and pain.

• Topical corticosteroids: May be used for severe inflammation or pruritus.

• Rest and hydration: Supportive care to aid in recovery.

• Avoidance of irritants: Patients should avoid heat, friction, and scratching of affected areas.

Antiviral therapy is generally not necessary, and antibiotics are not indicated unless there is a secondary bacterial infection.

Prognosis

The prognosis for papular purpuric gloves and socks syndrome is excellent. The rash typically resolves within 1 to 3 weeks without scarring or long-term effects. Recurrence is rare. While the condition can cause discomfort and concern due to its dramatic appearance, it does not usually lead to serious complications. In immunocompromised individuals, however, parvovirus B19 infection may lead to more severe consequences, such as aplastic anemia, and requires close monitoring. In healthy individuals, full recovery is expected with supportive care alone.