Morning Report

Morning ReportJanuary 11, 2011

Common Newborn Rashes

Vesiculobullous and Pustular lesions in the

newborn

Most common◦ Staphylococcus aureus

Other◦ Listeria◦ Strep species◦ Pseudomonas aeruginosa◦ Treponema pallidum◦ Hib

Bacterial Infections

Newborns especially susceptible to the exfoliative toxins

Protein cleavage in desmosomes

Tense bullae◦ Usually no longer

intact by presentation

Staph Scalded Skin Syndrome

Presentation◦ 3-7 days◦ Febrile◦ Irritable ◦ Diffuse blanching erythema

Flaccid blisters 1-2d later Mechanical stress Nikolsky’s sign

Flaky desquamation◦ May have conjunctivitis

Staph Scalded Skin Syndrome

Work up◦ Cultures

Blood Urine Nasopharynx Umbilicus Lesions

◦ Clinical Diagnosis Biopsy may be done if TEN is suspected

Staph Scalded Skin Syndrome

Treatment◦ IV penicillinase-resistant penicillin

Nafcillin or oxacillin◦ Consider vancomycin

Areas of high prevalence of CA-MRSA◦ Supportive skin care◦ Fluid management

Prognosis◦ Re-epithelialization in 1-2 weeks

Staph Scalded Skin Syndrome

First 5 weeks of life Hemorrhagic bullae and petechiae

◦ Start on palms and soles and spread to trunk Papulosquamous

◦ Similar to secondary syphillis Desquamative dermatitis

◦ Palms and soles

Congenital Syphillis

Days to weeks later

HSV VZV CMV Coxsackieviruses

Viral Infections

Intrapartum exposure Ascending infection

◦ May have intact membranes◦ Postnatal inoculation may occur

Symptoms◦ Days to 4 weeks

Neonatal HSV

3 patterns◦ Skin, eye, mouth◦ CNS◦ Fulminant

Skin lesions occur in majority of patients

Lesions◦ 1-3 mm vesicles and erythematous papules◦ May develop into pustules, crusts and erosions◦ 6-13 days of age

Neonatal HSV

Neonatal candidiasis◦ After first week of life◦ Moist, warm regions◦ Confluent erythema

Multiple tiny pustules Discrete erythematous

papules and plaques with superficial scales

Satellite lesions Congenital

cutaneous candidiasis

Fungal Infection

3-4 weeks of age at the earliest

Infants◦ Vesicles◦ Pustules◦ Crusting

Widespread◦ Hands, feet and wrists

Including palms and soles

Scabies

Epidermolysis bullosa

Epidermolytic hyperkeratosis◦ Bullous ichthyosis

Aplasia cutis congenita◦ Congenital focal absence of the skin

Incontinentia pigmenti

Congenital Disorders

May present with blisters in the newborn

Cutaneous Mastocytosis