Neonatal Dermatoses

1. Neonatal dermatoses

2. Vesicle,bullae,pustules
Transients
Erythema toxicum
neonatorum
Neonatal acne
transient neonatal
pustular melanosis
Infections
Congenital disease

3. Infections
Viral
infections
Herpes simplex
virus
Varicella zoster Cytomegalovirus coxsackieviruses
More cmmon

4. 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

5. The skin lesions typically consist of 1 to 3 mm vesicles
and erythematous papules that may develop into
pustules, crusts, and erosions

6. • 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.

8. 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

9. Bacterial infections
•Staphylococcus aureus (upto 60%)
•Listeria monocytogenes, Haemophilus influenzae type b
•Streptococcal species
•Pseudomonas aeruginosa
• Treponema pallidum
•Haemophilus influenzae type b

10. 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

11. • The diagnosis is confirmed-
• demonstration of Gram-positive cocci in
clusters and neutrophils on Gram stain
• Or growth on culture /blood culture

12. 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

13. • 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.

15. • 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 TEN
Treatment
• 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.

16. 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)

17. 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

18. 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

19. 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

20. • Satellite lesions are typically noted

21. • 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

22. 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

23. • 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

25. 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
Level
intraepidermal
intra-lamina
lucida
sub-basal
lamina

26. • 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

28. 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.

29. • 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

31. 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.