Papular purpuric gloves and socks syndrome: causes, symptoms, diagnosis, and treatment

Papular purpuric gloves and socks syndrome (PPGSS) is a less common exanthem mostly caused by parvovirus B19 and is characterized by itchy papules, petechiae, and edema on the hands and feet.


Causes

The disease is predominantly caused by parvovirus B19, followed by varicella-zoster virus, Epstein-Barr virus, cytomegalovirus, herpes virus 6, herpes virus 7, Coxsackie virus, hepatitis B virus, and rubella virus. Mycoplasma infection can also cause the disease. In addition, sulfamethoxazole and trimethoprim can also cause the disease.


Signs and Symptoms

The incubation period is 6 - 18 days. There are prodromal symptoms before eruption. The rash occurs 2 - 4 days after prodromal symptoms, persisting for 1 - 2 weeks.

Figure 1 papular purpuric gloves and socks syndrome on hands

Figure 2 papular purpuric gloves and socks syndrome on feet

The prodromal symptoms include fever, arthralgia, myalgia, anorexia, lymphadenopathy, and respiratory and intestinal symptoms. The rash usually occurs on the hands and feet, often bilaterally symmetrical. The wrists and ankles are often involved, and the rash looks like gloves and socks. The initial rash is glove-like, edematous erythema on both hands and sock-like, edematous erythema on both feet. The typical rash is scattered or fused maculopapular rashes and petechiae, and rare eruption can be manifested by vesicles and hemorrhagic vesicles. The subjective symptoms are pruritus and pain. In addition to the rash, the oral mucosa may be involved. There may be transient, mild anemia, leukopenia, neutropenia, eosinophilia, mononucleosis, thrombocytopenia, and elevated liver enzymes. Parvovirus B19 IgM antibodies are positive 10 - 13 days after infection, the positive test rate drops in 1 month, and the positivity can persist for 3 - 4 months. IgG antibodies are positive 9 - 36 days after infection.


Diagnosis

The diagnosis of this disease is mainly based on the typical distribution and morphology of the skin lesions.


Treatment

The disease is self-limiting, and symptomatic treatment is appropriate.