Neonatal Acne Research Articles

Skin colonization by Malassezia species in neonates: a prospective study and relationship with neonatal cephalic pustulosis.

To assess skin colonization by Malassezia species in full-term healthy newborns, to investigate factors associated with colonization, and to look at acnelike cephalic pustulosis associated with this carriage. Samples were obtained from neonates and their mothers 0 to 5 days after birth and again 3 weeks later. Clinical patterns of common acnelike pustulosis were reported as mild (<10 papulopustules), moderate (> or =10 papulopustules), or absent. Direct examination and culture of sample. Identification of yeasts was based on microscopic and physiologic criteria. A maternity hospital and the pediatric dermatology unit of a university hospital. Consecutive series of 102 neonates and their mothers. Incidence of skin colonization and type of Malassezia species found in neonates and correlation with neonatal cephalic pustulosis (neonatal acne). At the first visit, 11 neonates and 36 mothers had cultures positive for Malassezia. Malassezia sympodialis and Malassezia globosa were preferentially cultured. At 3 weeks, 29 (52%) of 56 neonates and 18 (32%) of 56 mothers had cultures positive for only M sympodialis and M globosa. Breastfeeding was not associated with a higher prevalence of Malassezia carriage in neonates. Malassezia colonization was higher when pustulosis was more severe and M sympodialis was found in pustules. Malassezia colonization begins at birth and increases in the first weeks of life. A high prevalence of M sympodialis in neonates is noted from birth. Its association with neonatal acne is confirmed. Further investigation is needed to study the role of sebum secretion rate and quality in the neonatal period.

Commentary: pediatric dermatology, part II

This special issue of the Clinics in Dermatology Journal, Pediatric Dermatology Part III, covers the management of common dermatologic problems in children. It is highlighted by the article from Lawrence Charles Parish and myself on the backgrounds, problems, and perspectives of management of common pediatric skin problems in developing countries. Wallach provided good information about the management of common benign neonatal diseases, which include neonatal acne, milia, miliaria, and toxicum neonatorum. Kurban and Al-Mahroos from Boston present a comprehensive chapter on the management of mastocytosis and another on sun protection. Schachner, Fulabella, and Bello give an overview on the management of epidermolysis bullosa, which Herane wrote a very nice chapter on vitiligo and leukoderma. Another chapter covered the treatment of cornification disorders in children, which is a challenging subject. Hypopigmentation in children is another challenge, and treatment is disappointing much of the time. The management of ichthyosis in infants and children is a continuing problem dealt with successfully by Rubeiz and Kibbi. Antihistamine and steroid use in pediatric dermatology is a very important topic that both dermatologists and pediatricians should recognize, as addressed in the chapter by Katsambas. The state-of-theart topic on pediatric cosmetic dermatology, is well executed by Lahti, Shabshi, Lewis, and Benedetto. Lastly the nutritional problems in children in developing countries is a major problem, and so its cutaneous aspect, was also included in this chapter. In his Foreword of the yearly issue of UNICEF’s The State of Health of the World’s Children 2002, Kofi A. Annan, Secretary-General of the United Nations, said:

Acne neonatorum: a study of 22 cases.

Acne is not uncommon in the neonatal period. Acne neonatorum is characterized by a mainly facial eruption of inflammatory and noninflammatory lesions. It is most commonly mild and transient. Hyperactivity of sebaceous glands, stimulated by neonatal androgens, has been implicated as the underlying pathogenetic mechanism. All patients diagnosed with acne neonatorum in "A. Sygros" Hospital, Athens, Greece, during the years 1993-1996, were evaluated clinically and epidemiologically. Histologic examination and smears for Propionibacterium acnes and Pityrosporum ovale were performed in selected cases. Of the 22 patients studied, 18 were male (81.8%) and 4 were female. The mean age at onset was 3 weeks and the mean duration of the disease was 4 months. Papules and pustules were the most frequent types of lesions (72.7%), followed by comedones only (22.7%). The cheeks were the most common site of predilection (81.8%). A family history of acne was reported in only three patients. Histologic examination showed hyperplastic sebaceous glands with keratin-plugged orifices. Smears for P. ovale were negative. Our findings are consistent with previous experience, although inflammatory lesions were encountered more often than previously reported. Hereditary factors did not seem to play a significant role in our series. Topical treatment hastened the resolution of this self-limited condition. Recalcitrant cases warrant investigation for underlying androgen excess.

Is common neonatal cephalic pustulosis (neonatal acne) triggered by Malassezia sympodialis?

A type of neonatal cephalic pustulosis that is clinically similar to classic neonatal acne recently has been linked to Malassezia furfur infection. To correlate the mycological and clinical findings in neonates with cephalic pustulosis, we carried out a prospective case-control study in a neonatal unit from February to April 1997 using new techniques for classifying Malassezia species. Nineteen patients with cephalic pustulosis and 19 controls younger than 45 days were studied among 161 consecutively hospitalized infants. Cultures from swabs and smears of pustules were obtained from patients, and swabs from healthy site-matched skin were obtained from controls. Three patients were excluded from the study because another cause of pustulosis was found. A blank sampling of pustules was obtained from 2 patients. Test results for 6 of 16 patients were positive for Malassezia sympodialis on contralateral nonpustular skin, and 4 of those patients also had positive cultures for M sympodialis. Cultures from 6 to 19 controls were positive (4 for M furfur and 2 for M sympodialis). The prevalence of Malassezia species increased with age, and the severity of the pustulosis was correlated with the isolation of M sympodialis. Our data suggest that M sympodialis triggers the severe form of common cephalic pustulosis in infants with this benign disorder.

Distinguishing vesicular and pustular disorders in the neonate.

Vesicular and pustular disorders are common in the neonatal period. Most are benign, but several serious infectious and noninfectious diseases can present in the neonate. This review focuses on the clinical features of these disorders as well as recent advances in the field. The following diseases are discussed: erythema toxicum, transient neonatal pustular melanosis, miliaria, neonatal acne, eosinophilic folliculitis, mastocytosis, acropustulosis of infancy, incontinentia pigmenti, scabies, neonatal and congenital candidiasis, syphilis, neonatal herpes simplex infections, neonatal varicella, and staphylococcal infections.

Diagnosis and treatment of pustular disorders in the neonate.

The diagnosis of a pustular dermatosis occurring during the first months of life is usually based on clinical findings. However, some cases may require simple investigations including microscopic examination of pustular content, cultures, and skin biopsies. The main benign transient neonatal types of pustulosis include erythema toxicum neonatorum, infantile acropustulosis, transient neonatal pustular melanosis, and neonatal acne. The most common causes of infectious pustular skin lesions include bacterial infections, which may be initially localized (Staphylococcus aureus) or septicemic (with Listeria monocytogenes as the leading causitive agent); viral infections (herpes simplex, varicella-zoster, and cytomegalovirus infections); fungal infections (candidiasis); or parasitic disorders (scabies). The main objective of this article is to propose a systematic approach to pustular eruptions in the neonate. The need for investigating every neonate with pustules for an infectious disease is emphasized. The Tzanck smear, the Gram's stain, and a potassium hydroxide preparation are the most important quick diagnostic tests. The Tzanck smear is a very easy, rapid, and sensitive test for detection of a herpetic infection (multinucleated giant cells) as well as noninfectious pustular eruptions (eosinophils, neutrophils). Therefore the Tzanck smear should be the first test performed. Moreover, a Gram's stain and potassium hydroxide preparation should be performed in cases of neonatal pustular disorders to detect bacterial and fungal infections. The goal of this diagnostic approach is to spare a healthy neonate with a benign transient condition an invasive evaluation for sepsis, potentially harmful antibiotic therapy, and prolonged hospitalization, with its own inherent morbidity.

Pathogenesis and treatment of acne in childhood.

Acne occurs more frequently in newborns and infants than one would gather from written accounts. Acne neonatorum tends to be overlooked because it is usually minor and transient. In contrast, acne infantum, which generally does not make its appearance until after 3 months of life, is more serious. Even acne conglobata may develop in infants. There are many other types of acne in childhood reflecting different pathogenetic mechanisms; included in this group are acne venenata infantum, steroid acne, hormonal disturbances, and toxic reactions.

Neonatal Malassezia furfur Pustulosis

Papulopustular eruptions of the face in neonates are frequently referred to as neonatal acne or sebaceous miliaria. Our findings suggest that there is an association between this type of eruption and Malassezia furfur infection. Direct examination of pustule smears showed M furfur yeasts in eight of 13 cases involving neonates with erythema and papulopustules of the face, neck, and scalp (mean age at onset, 22 days [range, 7 to 30 days]). The pustules were predominantly neutrophilic. Treatment with 2% ketoconazole cream applied topically twice daily was effective in 1 week. Malassezia furfur is frequently associated with a common nonfollicular pustulosis of the newborn, probably improperly termed neonatal acne.

Nodulocystic Infantile Acne Occurring in a Kindred of Steatocystoma

To the Editor.— Cases of infantile nodulocystic acne have been reported since 1926. 1-6 Hellier 4 divided acneiform eruptions of infancy into two groups. The first group included those patients in whom lesions developed during the first few weeks of life (neonatal acne, acne neonatorum, and grouped comedones of infants and children), while the second group consisted of those that developed lesions at the age of about a year or more. It was his experience that in the older group, lesions tended to be fewer and often took the form of cold abscesses. We describe a girl who developed nodulocystic acne at the age of 18 months and who was a member of a kindred with extensive steatocystoma multiplex. Report of a Case.— A 23-month-old girl was seen in January 1985. Her gestation and delivery were normal. She was well until 18 months of age, at which time she began

Epileptic Seizures. Clinical and Electrographic Features, Diagnosis and Treatment.

Physicians examining newborn infants should no longer dread the discovery of unusual skin problems. Practical dermatologic help is now available in this highly readable text, the first in English dealing exclusively with neonatal skin. It particularly encourages pediatricians to carefully examine the skin of newborns for signs of prematurity, infection, inherited disease, and birth trauma. Detection of premature skin with its poor vasomotor tone, inability to sweat, and reduced fat pad insulation signals danger of thermal instability and the need for controlled environmental temperature. Increased percutaneous absorption in such skin adds additional risk from bathing with toxic substances such as hexachlorophene or boric acid. Increased desquamation occurs with prolonged gestation of 40 to 42 weeks and with dysmaturity from prenatal anoxia. Dysmature skin also demonstrates meconium staining and long hair and nails. Nursery personnel should readily recognize the common, transient, benign skin lesions described in this book, as concerned mothers will appreciate intelligible explanations for milia, miliaria, salmon patches, mongolian spots, erythema toxicum neonatorum, cutis marmorata, and neonatal acne. Detailed information is also given for many severe skin dis¬ eases, which are organized by chap¬ ters into morphologically similar groups such as vesiculobullous erup¬ tions, scaling disorders, and vascular malformations. Special attention is given to pigmentary disorders indica¬ tive of genetic diseases like neurofibromatosis and tuberous sclerosis. The dermatologie novice will bene¬ fit greatly from chapters on basic ter¬ minology, diagnostic technique, and topical therapy. Also helpful are the plentiful references, current to 1972, and numerous tables which consoli¬ date key facts, such as causes of pur¬ pura, signs of congenital syphilis, and types of ichthyosis. Photographs are abundant, with 62 in color, but are of

Acne comedo in children due to paraffin oil applied on the head.

FROM AMONG the various factors which help to produce acne vulgaris, the most important are, undoubtedly, the sex hormones, and it therefore occurs principally during puberty. The androgens are especially acnegenic because of their stimulating effect on the pilosebaceous apparatus, as is clearly shown clinically and experimentally in rats 1 and in human beings. * The usual premenstrual flare-up of the disease is explained by some investigators by the fact that in this period the amount of folliculin in the blood is at its lowest level with the result that the normal androgen-estrogen balance is altered in favor of androgen. It is very likely that acne neonatorum, too, can be partially explained on a hormonal basis. The blood of a pregnant woman contains great quantities of estrogens, which readily pass through the placenta, enter the fetal bloodstream, and then in the newborn sometimes cause infantile seborrhea and, occasionally, also