Sir,

Palmoplantar desquamative erythema is a frequent reason for consultation in dermatology. Several diagnoses are to be discussed. We report a case of an infant with recurrent desquamative acral erythema in relation to Fereol-Besnier disease.

This is an 18-month baby girl from a first-degree consanguineous marriage, who presented since the age of 1 year recurrent episodes of flaky desquamative erythema at palmoplantar surface, aggravated by the exposition to water, spaced 4 to 8 weeks apart and regressing in 3 days. There were no concomitant infections, medication, digestive disorders or similar cases in the family. The clinical examination showed a healthy infant in good general condition with a palmo-plantar desquamative erythema; a positive bucket sign, without associated adenopathies or hyperhidrosis (Fig. 1).

Figure 1: Erythematous scarlatiniform rash in our case.

In front of this picture several diagnoses were discussed in particular the disease of Féréol-Besnier in its localized form, the palmo-plantar aquagenic keratosis, Lane disease, acral peeling syndrome and others. An emollient and an antibiotic therapy containing amoxicillin were prescribed with a good evolution.

The absence of similar cases in the family and the occurrence of desquamative erythema even outside of water exposure led to the diagnosis of Fereol-Besnier disease or erythema scarlatiniforme desquamans recurrence (ESDR).

In the literature, few cases have been reported. This disease was first described by Fereol in 1876, by unknown origin; hyperallergic reactions to drugs and infections have been suggested. There are two known variants of this disease: a generalized form, preceded by a flu-like symptoms, and a form localized at the palmoplantar area, often asymptomatic, with few prodromes [1–3].

In its localized form, it is characterized clinically by a maculoerythematous rash followed by lamellar desquamation (Fig. 2) [1–4]. This disease heals spontaneously in two to four weeks [2,4,5]. At this time, there is no specific therapeutic recommendation. Topical steroids and systemic antibiotics have little or no effect on the natural course of this disease and do not prevent recurrences [2,6]. ESDR remains a mild, self-limiting disease.

Figure 2: Palmar desquamation in flaps on an erythematous background.

The most appropriate treatment is symptomatic management (emollients and keratolytics) [1,2,6].

Fereol-Besnier disease is an underdiagnosed and poorly understood entity, particularly in the localized form. Recognition of this condition is important to prevent diagnostic and therapeutic escalation.

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