Neonatal dermatoses

Vesicle,bullae,pustules

Transients

Erythema toxicum neonatorum

Neonatal acne

transient neonatal pustular melanosis

Infections

Congenital disease

Infections

Viral infections

Herpes simplex

virus

Varicella zoster

Cytomegalovirus

coxsackieviruses

More cmmon

Herpes simplex

• Neonatal HSV infection primarily results from intrapartum exposure

• Postnatal inoculation also may occur• HSV infection in newborns usually develops in one

of three patterns: ●Localized to the skin, eyes, and mouth ●Localized central nervous system (CNS) disease ●Fulminant, disseminated disease involving

multiple organs

The skin lesions typically consist of 1 to 3 mm vesicles and erythematous papules that may develop into

pustules, crusts, and erosions

• It is common in premature, low birth weight, and microcephalic

• most lesions in older children are self-limited• Neonatal infections are more likely to disseminate• Newborns with disseminated disease often appear

septic, with vascular instability, hepatic dysfunction, disseminated intravascular coagulation, and/or respiratory failure.

• CNS disease presents with fever, lethargy, and focal seizures.

Varicella zoster

• Neonatal varicella is a serious illness associated with a mortality rate up to 25 %

• Newborn with mother exposed to or having C/F within two weeks of delivery are at risk

• lesions are polymorphous-• papules, pustules and vesicles

Bacterial infections•Staphylococcus aureus (upto 60%)

•Listeria monocytogenes, Haemophilus influenzae type b

•Streptococcal species

•Pseudomonas aeruginosa

• Treponema pallidum

•Haemophilus influenzae type b

Staphylococcal pyoderma

• S. aureus can directly infect the skin, resulting in pyoderma

• Characterized by pustules, erythematous papules, and honey-colored crusts

• usually are found in areas of trauma, such as the diaper area, circumcision wound, axillae, and periumbilical skin

• Although they may appear anywhere on the body

• The diagnosis is confirmed-• demonstration of Gram-positive cocci in

clusters and neutrophils on Gram stain• Or growth on culture /blood culture

Staphylococcal scalded skin syndrome

• Also known as Ritter disease• The toxins act at the zona granulosa of the

epidermis, causing cleavage of desmoglein 1 complex an important protein in desmosomes

• Causing fragile, tense bullae that often are no longer intact by the time of presentation

• Presentation usually occurs at three to seven days of age

• Neonates are febrile and irritable• with diffuse blanching erythema often beginning around

the mouth.• Flaccid blisters appear one to two days later, especially in

areas of mechanical stress including flexural areas, buttocks, hands, and feet

• Gentle pressure applied to the skin results in separation of the upper epidermis and wrinkling of the skin (Nikolsky's sign)

• Mucous membranes are not involved but may appear hyperemic.

• If SSSS is suspected, cultures should be obtained from blood, urine, nasopharynx, umbilicus, abnormal skin, or any suspected focus of infection.

• The intact bullae are sterile• Diagnosis is clinical but may require biopsy to differentiate from SJS and TENTreatment• Prompt administration of intravenous penicillinase-resistant penicillin, such as

nafcillin or oxacillin• Vancomycin should be considered in areas with a high prevalence of Community

Aquired-MRSA• Supportive skin care should be provided • with the use of emollients, such as creams or ointments, to improve barrier

function.• Fluid and electrolyte status should be monitored with losses replaced as needed.

Streptococcal

• Epidemics of group A streptococcus (GAS)- affected newborns may present with pustules and honey-colored crusts, often in association with a moist umbilical cord stump or omphalitis

• Group B streptococci (GBS) most commonly cause neonatal sepsis.

• Treatment of GAS includes parenteral antibiotics and surveillance for evidence of invasive infection.

• For isolated GBS skin lesions, intramuscular penicillin (25,000 to 50,000 units every eight hours for 10 days)

Listeriosis

• Listeria monocytogenes• Clinical manifestations can occur early, before

seven days, or late, after seven days• Both forms can present with meningitis and

signs of septicemia• Infants with the early form often have multiple

pustules on the skin and mucous membranes

Congenital syphilis

• Congenital syphilis occurs when the spirochete T. pallidum is transmitted from a pregnant woman to her fetus

• Hemorrhagic bullae and petechiae that start on the palms and soles and spread to the trunk and extremities are nearly pathognomonic of congenital syphilis

• If ulcerative in nature, they are highly contagious• Early manifestations include rhinitis (snuffles), anemia,

thrombocytopenia, lymphadenopathy, hepatomegaly, fever, and poor feeding

Fungal infection

• Neonatal candidiasis • develops after the first week of life• to affect moist, warm regions and skin folds, such as in

the diaper area, or mucous membranes in the mouth, where it is known as thrush

• Candidal diaper dermatitis characteristically appears as an erythematous rash in the inguinal region

• The rash classically has areas of confluent erythema with multiple tiny pustules or discrete erythematous papules and plaques with superficial scales

• Satellite lesions are typically noted

• Oropharyngeal candidiasis or thrush – Pseudomembranous form is the most

common and appears as white plaques on the buccal mucosa, palate, tongue, or the oropharynx

• Topical therapy (eg, nystatin) is usually effective. In breastfeeding infants, the mother also may require treatment

SCABIES

• caused by infestation with the Sarcoptes scabiei mite• The skin eruption is because of a hypersensitivity

reaction to the proteins of the female parasite• which burrows into the upper layers of the epidermis• Transmission of scabies is usually from person to

person by direct contact• Scabies may present as early as three to four weeks of

age and is never present at birth• Infants are likely to develop vesicles, pustules, and

crusting

• Diagnosis considered with vesiculopustular eruption that involves the palms and soles

• Treatment- • one application of permethrin 5 percent cream

at bedtime to all skin surfaces in infants and from the neck down in older family members

• An alternative therapy for newborns is the application of 5 to 10 percent precipitated sulfur in petrolatum

CONGENITAL DISORDERS

• Epidermolysis bullosa • Is group of inherited diseases characterized by

skin fragility and blister formation caused by minor skin trauma

Type

EB simplex

junctional EB

dystrophic EB

• Management• Consists of prevention of trauma, careful wound

care, and treatment of infection• More severe forms of EB, such as recessive

dystrophic EB, require intensive palliative and supportive measures

• To prvent common complications such as pain, nutritional deficiencies, life-threatening infections, and debilitating deformities secondary to scarring of the skin and mucosa

Incontinentia pigmenti • an X-linked dominant multisystem disease that is usually lethal in

males• The skin lesions develop in four stages:• ●Erythematous papules and vesicles appear in crops in linear streaks

along the lines of Blaschko, usually beginning at birth or within the first few weeks of life, with each crop lasting one to two weeks

• ●The verrucous stage follows, consisting of hyperkeratotic warty papules or plaques in linear or swirling patterns

• ●The third pigmented stage presents as streaks of hyperpigmentation in a "marble cake pattern”

• ●The hyperpigmented streaks then may evolve into a final stage of hypopigmentation and atrophic patches or streaks.

• cutaneous changes include patchy alopecia, woolly-hair nevus, and nail dystrophy.

• Systemic abnormalities occur in nearly 80 percent of patients-dental, ocular and neurological problems

• The clinical diagnosis is confirmed with skin biopsy

CUTANEOUS MASTOCYTOSIS

• mastocytosis is an infiltrative skin disorder that can present with blisters in the newborn.

• The two main forms are • Urticaria pigmentosa-which may consist of

solitary or multiple lesions• Rarely, diffuse cutaneous mastocytosis.