Gloves and Socks Syndrome (PPGSS) is an uncommon skin condition primarily affecting the hands and feet. This dermatosis is characterized by a sharply defined, symmetrical rash that gives the syndrome its name. It is a benign, temporary illness, most often seen in young adults. The syndrome is self-limiting, resolving on its own without specific medical intervention.
The Appearance of the Rash
The rash appears symmetrically on the distal extremities. It begins with painful redness (erythema) and swelling (edema) primarily on the hands and feet. The rash rapidly progresses to form papules (bumpy texture) and purpura, which are small, non-blanching red or purple spots caused by bleeding under the skin.
The pattern mimics wearing gloves and socks, stopping abruptly at the wrists and ankles. This creates a clear line of demarcation between affected and unaffected skin. While focused on the hands and feet, the rash may occasionally spread to the elbows, knees, or cheeks. Small fluid-filled blisters (vesicles) may also develop on the affected surfaces.
What Causes Gloves and Socks Syndrome
PPGSS is an immune-mediated reaction, usually triggered by a viral infection. The most frequent cause is Human Parvovirus B19 (B19V), which also causes Fifth Disease. The syndrome occurs when the body’s immune system responds to circulating viral antigens.
This immune response causes inflammation, leading to vasculitis (inflammation of the blood vessels) in the small venules of the affected areas. This inflammation and subsequent leakage from the vessels result in the distinctive purpuric rash.
While B19V is the primary trigger, other pathogens have been associated with PPGSS:
- Human Herpesvirus 6 (HHV-6)
- Cytomegalovirus (CMV)
- Epstein-Barr virus
- Hepatitis B
- Adenovirus
- Influenza
Rarely, non-viral factors, such as certain medications like trimethoprim/sulfamethoxazole, can also trigger the syndrome.
Non-Dermatological Symptoms
The rash is often preceded or accompanied by systemic symptoms typical of a mild viral illness. Patients commonly experience a prodrome including low-grade fever, malaise, and fatigue.
Systemic involvement includes lymphadenopathy (swelling of lymph nodes), particularly in the neck and groin. Mouth sores (enanthem) may also accompany the rash, presenting as small ulcers on the mucous membranes.
Another common complaint, especially in adults, is arthralgia (joint pain). This discomfort can affect multiple joints (polyarthropathy) and is a known feature of Parvovirus B19 infection.
Treatment and Expected Recovery
The prognosis for PPGSS is favorable, as the condition is self-limiting and resolves without long-term complications. Treatment is primarily supportive, focusing on managing discomfort while the body clears the viral infection.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce pain, fever, and joint aches. Topical corticosteroids, such as triamcinolone cream, can be applied to the rash to reduce itching and inflammation. The skin manifestations typically resolve within one to three weeks.
The period of highest infectivity for the underlying viral cause usually occurs before the rash develops. Once the rash appears, the patient is generally past the stage of being highly contagious. Patients can resume normal activities once systemic symptoms, like fever and malaise, have subsided.