Neonatal Skin Lesions Research Articles

Cutaneous findings in neonates and their socio-demographic profile: a prospective observational study

Background: A wide range of disorders can manifest as skin lesions due to the great difficulty the skin encounters while transitioning from an aqueous to a dry environment in a neonate. Among the skin conditions commonly seen in neonates are temporary benign lesions, atopic dermatitis (and associated disorders), bullous dermatoses. Aim was to study the various patterns of skin lesions in neonates and to estimate the prevalence of physiological and pathological skin lesions. Methods: This prospective observational study was conducted in the department of pediatrics at Acharya Shri Chander College of Medical Sciences and Hospital (ASCOMS) a tertiary care hospital in Jammu. A total of 300 neonates (day 1 to day 28 of life) and having any skin lesions or manifestations born at the hospital or visiting out patient’s department were included in the study. The data collected was compiled on excel sheet and was analyzed statistically by using statistical package for the social sciences (SPSS) software version 21.0. Results: It was found that the most of the skin manifestations were observed in neonates born to multiparous mothers at term gestation and having average weight. The male to female ratio was 1.3:1. The frequency of the cutaneous manifestations were seen more in neonates born via the caesarean section. Conclusions: It is concluded that the most common skin lesion was erythema toxicum followed by icterus neonatorum.

Neonatal Dermatopathology: A 10-Year Institutional Review

Background/objective Neonatal skin conditions are typically diagnosed through noninvasive methods. Few studies describe the spectrum of biopsy- evaluated neonatal skin lesions. We present our institutional experience with the conditions leading to skin biopsies in neonates. The objective is to describe the conditions for which skin biopsies are performed in neonatal patients. Methods There were 20 neonatal skin biopsies over a 10-year period from the hospital’s delivery unit, NICU, and pediatric hospital. Biopsies were categorized as inflammatory (not caused by an infectious agent), congenital, neoplastic, infectious, and vascular conditions. Results The patients’ ages ranged from 1 day to 4 weeks, with a male predominance. There were 6 inflammatory, 7 congenital, 5 neoplastic, 1 infectious, and 1 vascular lesions. Conclusions The most frequent neonatal skin biopsy lesions were inflammatory or congenital lesions. This review described the types of neonatal dermatopathology specimens that we encountered in practice.

Two cases of KRT1 mutation-associated epidermolytic ichthyosis without typical epidermolytic hyperkeratosis in the neonatal skin lesions.

Epidermolytic ichthyosis (EI) is a rare genetic disorder of keratinization caused by mutations in either KRT1 or KRT10. Histopathologically, epidermolytic hyperkeratosis (EHK) is a hallmark of EI. Here, we report two EI cases in which KRT1 mutation was confirmed by molecular study, but without typical EHK present on skin biopsies performed within 1 week of age. Our cases demonstrate that EHK may not be evident in EI if skin biopsy is performed during the neonatal period.

A Clinical Study of Dermatoses in Neonatal Intensive Care Unit in a Tertiary Health-Care Center

Introduction: Neonatal period is defined as the first 4 weeks of extrauterine life. The skin and appendages of the newborn present different features compared to adults. The imperative knowledge of normal phenomena and their differentiation from the more significant cutaneous disorders of the newborn is critical for dermatologists for timely intervention, which could facilitate a better therapeutic outcome. Materials and Methods: We conducted a hospital-based, observational, cross-sectional study of a total of 128 neonates with cutaneous manifestation from May 2021 to November 2021. Results were analyzed statistically. Results: Of all neonates examined, i.e., 128, 77 (60.15%) were male and 51 (39.85%) were female, with a male: female ratio of 1.5:1. 87 (67.96%) neonates were term, 35 (27.34%) were preterm, and 6 (4.68%) were postterm. 33 (25.78%) neonates had more than one cutaneous lesion. Of all the cutaneous lesions, physiological skin lesions were most common, which accounted for 70% of skin lesions, followed by iatrogenic 8%, transient noninfective conditions 5%, eczema 5%, developmental defects 4%, birthmarks 4%, and others 4%. Conclusion: Neonatal skin lesions are often physiological. Both dermatologists and pediatricians have to be aware of the course of the disease. Nursing mothers have to be explained the natural course of the skin lesions to reduce unnecessary anxiety; whereas to reduce iatrogenic infections, nursing staff has to be explained to handle newborn’s skin with care as they are sensitive.

Congenital candidiasis – a diagnostic challenge

Introduction: Congenital candidiasis is a rare intrauterine infection characterized by vesicular and pustular skin lesions appearing in the first six days of life. Clinical case: The authors describe the case of a full-term infant presenting erythematous macules, vesicles and pustules involving the trunk and extremities and cervical burn-like dermatitis at birth. Mycological skin lesion culture was positive for Candida albicans. Blood culture was positive for methicillin-sensitive Staphylococcus aureus. After systemic antifungal and antibiotic therapy was started, the newborn remained asymptomatic with lesion improvement. Discussion/ Conclusion: Herein is reported a case of congenital candidiasis in a full-term infant, with a successful recovery. The rarity of congenital candidiasis can lead to delayed diagnosis and unnecessary treatment. This case shows that fungal infection should be considered in the differential diagnosis of vesiculopustular skin lesions in neonates. Systemic therapy should be initiated if invasive candidiasis is suspected.

A clinical study of various cutaneous manifestations in neonates

<p class="abstract"><strong>Background:</strong> Cutaneous manifestations are common in neonates. Transient and pathological neonatal dermatoses should be differentiated to avoid unnecessary treatment and thus considering the variable nature and severity of neonatal skin lesions, it is important to be aware of the transient skin lesions in newborn and to differentiate these from other serious conditions which will avoid unnecessary therapy to the neonates and the parents can be assured of good prognosis of these skin manifestations. The present study has been carried out to study the clinical pattern of cutaneous lesion in neonatal period.</p><p class="abstract"><strong>Methods:</strong> A total of 255 neonates from Department of Dermatology in collaboration of Department of Pediatrics, Era’s Lucknow Medical College and Hospital were evaluated for cutaneous manifestations. A detailed assessment regarding history, clinical examination and investigations were recorded and analyzed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 255 neonates, 138 (54.1%) were males and 117 (45.9%) were females. The sex ratio (M:F) was 1.18. The most common dermatoses were physiological desquamation (54.1%) and mongolian spots (37.6%) followed by milia (19.6%), miliaria (14%), epstein pearls (10.2%).</p><p class="abstract"><strong>Conclusions:</strong> The physiological and transient cutaneous lesions are common are in neonates. Physiological cutaneous manifestations were quite frequent apart from birthmarks/congenital cutaneous manifestations. An understanding of these manifestations helps in managing and deciding the appropriate manifestation.</p>

Common Neonatal Skin Lesions: Melanocytic Nevi, Pigment Alterations, and Nonmelanocytic Nevi.

Birthmarks are common in the healthy population and are generally harmless. Certain presentations, however, raise concern for associated syndromes or potential complications. It is important for pediatricians to be familiar with both harmless and potentially concerning birthmarks. This article discusses congenital melanocytic nevi, café-au-lait macules, hypomelanotic macules, nevus depigmentosus, nevus anemicus, epidermal nevi, and nevus sebaceous, including potential syndromes and complications. [Pediatr Ann. 2019;48(1):e23-e29.].

Effect of Providing Ostomy Care Education to Mothers of Neonates with Peristomal Skin Complications

Abstract Introduction: Ostomy is a surgical procedure performed to divert feces and urine output in cases of anorectal anomalies. Although this procedure is a crucial intervention with excellent treatment effect, it is associated with complications, such peristomal skin lesions. This study aimed at evaluating the effect of providing ostomy care education to mothers of infants with peristomal skin complications. Methods: Forty mothers of neonates with intestinal stomies were informed about the aim of this study and invited to participate. The sampling was conducted in accordance with the quota sampling method. The participants were randomly and equally allocated to the control and experimental groups. The mothers in the experimental group attended a three-session educational program, whereas the mothers in the control group received information about routine care methods used by the study settings. The peristomal skin conditions of the infants in both groups were examined before discharge and 30 days after discharge using the Telegram Software or in person, according to an established checklist. Data were analyzed with the SPSS 21 software to obtain descriptive and analytical statistics. Results: Prior to discharge, the majority of the neonates in both groups had healthy peristomal skin. In the control group, five neonates had acute dermatitis and one had chronic dermatitis. In the experimental group, four neonates had acute dermatitis and two had chronic dermatitis. The χ-square test showed that the two groups were not significantly different (p-value = 0.94). After discharge, most of the neonates in the experimental group had intact peristomal skin and only four neonates had chronic dermatitis. In contrast, in the control group, only six neonates had intact peristomal skin. The results of Fisher’s exact test indicated that the two groups of study were significantly different (p-value = 0.013). In the experimental group, 16 and 14 neonates had intact peristomal skin before and after discharge, respectively. In the control group, 14 and 6 neonates had intact peristomal skin before and after discharge, respectively. The results of McNemar’s test revealed no significant differences in the experimental group before and after discharge (p-value = 0.69), whereas the control group showed significant difference in this context (p-value = 0.021). Conclusions: Providing mothers with education on proper ostomy care significantly decreased the occurrence of peristomal skin lesions in neonates with intestinal ostomies.

Clinical study of neonatal skin lesions

<div class="WordSection1"><p class="abstract"><strong>Background:</strong> <span lang="EN-IN">A thorough knowledge of the skin changes, physiological as well as acquired, in neonates is of prime importance for the dermatologist as well as paediatrician.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A total of 430 randomly selected live-born neonates delivered and admitted to the postpartum ward or to the Neonatal Intensive Care Unit and neonates attending the Dermatology Outpatient Department of a tertiary care institute were included in this study after taking written informed consent. A detailed assessment of history was performed and a detailed dermatological examination of each neonate was carried out. Laboratory procedures were performed to confirm diagnosis if required. Data was analyzed using SPSS ver. 20</span>.</p><p class="abstract"><strong>Results:</strong> Most common physiological skin change observed was Mongolian spot (65.35%) followed by Erythema Toxicum Neonatorum (51.63%), Epstein’s pearls (46.97%) and Sebaceous gland hyperplasia (45.81%). Lanugo hair was seen in 16.74% neonates. Among congenital skin lesions, Salmon patch was seen in 15.58% of the neonates whereas congenital melanocytic nevi are seen in 4.19% of the neonates. <span lang="EN-IN">Diaper dermatitis was the most common acquired skin manifestation seen in 5.81% of cases. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Neonates are prone to suffer from a wide range of dermatological problems, physiological as well as pathological. These manifestations are unique to the neonates. A detailed history and awareness of the clinical presentation facilitates the confirmation of the diagnosis.</span></p></div>

A Sinister Cause of Bruising in a “Well” Neonate

Neonatal purpura fulminans is a clinical entity characterised by echymotic skin lesions, consumptive coagulopathy and widespread micro and macro vascular thrombosis. This can be hereditary or secondary to acquired causes. Clinical presentation of hereditary Protein C deficiency can be solely limited to localised echymotic skin lesions in the early stage, with wide spread vascular thrombosis ensuing eventually, in the absence of timely Protein C replacement. A case of a neonate presenting with localised scalp ecchymosis at birth, that soon progressed to skin necrosis and renal vein thrombosis is discussed. The report aims to raise awareness among neonatologists regarding the need to consider this rare condition with potentially devastating consequences, while evaluating bruise-like skin lesions in neonates.

Clinical Study on Prevalence of Cutaneous Lesions in New Born Babies in India

Background: Skin being the major organ of human body, any lesion on the newborn can cause concern and anxiety to parents. Many such lesions can be physiological and transient. There are very few reports in the literature regarding the cutaneous manifestations in newborns in India. Aim: This study is undertaken to determine the prevalence and pattern of various skin lesions in neonates and to correlate the relationship between new born skin lesions to gestational age, birth weight, mode of delivery, sex and maternal factors. Materials and methods: All new born delivered at a referral hospital between 2013-2015 were included for the study. Data regarding maternal age, illness, drugs, gestational age, mode of delivery, birth weight, sex of new born were noted. All the new born were clinically examined for skin lesions during their stay in hospital. Results: Total of 1427 live births was included. Out of this 92.1% of newborns had skin lesions and 7.9% had no skin lesions. The incidence of single lesion was 25.4% and multiple in 66.5%. Common manifestations included mangolian spots, milia, ebstein pearls, erythema toxicum neonatorum. Our study showed increased incidence of mangolian spots, lanugo hairs and cutis marmorata in new-borns of mothers having illness and in preterms. Birth injuries were more in instrument assisted deliveries. The skin peeling and birth marks were more in posterms. However there was no difference in the manifestations between male and female babies. Conclusion: Majority of the skin lesions are transient and physiological which does not require any treatment. Recognizing these transient lesions in new born will avoid unnecessary therapy to the new-borns and it will enable the paediatrician to allay parental concern and anxiety.

Giant intracranial hemangioma in a neonate

In this report we detail the case of an infant presenting with a giant intracranial congenital hemangioma and describe the clinical features and surgical management. Congenital hemangiomas are benign vascular tumors that typically present as skin lesions in neonates and infants. On rare occasions they present as intracranial tumors. The possibility that these tumors may undergo spontaneous regression poses a treatment dilemma.

A newborn with widespread skin lesions and extremity anomalies

A variety of diseases can cause vesicular or pustular eruptions in newborns. A thorough clinical history and physical exam provide important clues for differential diagnosis. Goltz syndrome, also known as focal dermal hypoplasia, is a rare genodermatosis and generally diagnosed by the presence of the characteristic skin lesions. We present an infant with aplasia cutis, atrophic skin lesions, syndactyly and eye abnormalities who was diagnosed with Goltz syndrome soon after birth. Goltz syndrome should be considered in differential diagnosis of hypoplastic or aplastic skin lesions in neonates in the presence of skeletal or ophthalmic anomalies.

Educational paper: neonatal skin lesions

Although most skin lesions in neonates are transient or benign, they may also be the presenting symptom of a life-threatening disease such as herpes neonatorum. In the present review, we present a short overview of neonatal skin lesions and a practical table to guide the general paediatrician in the diagnosis and management of neonatal skin lesions. Recent reviews are cited for further reading.

Pemphiguserkrankungen bei Kindern und Jugendlichen

The pemphigus diseases, which include some of the most severe bullous autoimmune skin reactions, are seen predominantly in middle-aged and elderly individuals. Only endemic pemphigus foliaceus in South America most frequently affects juveniles and children. All non-endemic pemphigus diseases, including paraneoplastic pemphigus, have been reported to occur in adolescents and even very rarely in children younger than 10 years. Pemphigus vulgaris in pregnancy represents a frequently overseen medical problem and may result in fetal growth retardation, intrauterine death, premature delivery and - in about 30% - in neonatal pemphigus vulgaris of the newborn. Contrary to pemphigus vulgaris, the transplacental crossing of autoantibodies against desmoglein1 in pregnant women with pemphigus foliaceus hardly ever leads to neonatal skin lesions in the offspring. This phenomenon can be explained by differences in the distribution and cross-compensation of the pemphigus antigens desmoglein3 and 1 in neonatal and adult skin or mucosa, respectively.

Birthmarks of Potential Medical Significance

After completing this article, readers should be able to: 1. Describe the clinical manifestations of neurofibromatosis type 1. 2. List conditions associated with cafe au lait macules. 3. Explain the clinical significance of congenital melanocytic nevi. 4. Characterize tuberous sclerosis complex. 5. List the two syndromes associated with port-wine stains and extracutaneous abnormalities. 6. Categorize and describe the three types of hemangiomas. Birthmarks are common (∼8% to 10%) in newborns. Most birthmarks represent vascular and pigmentary lesions. The natural history of these lesions varies from being transient phenomena and essentially normal variants of no clinical significance to permanent cutaneous abnormalities that may be associated with significant systemic complications or diseases. Table 1 lists some neonatal skin lesions that should be recognized by the clinician as clues to more serious disorders. | Hyperpigmented Birthmarks | || | | | Hypopigmented Birthmarks (“white spots”) | | Vascular Birthmarks | | • Vascular Malformations | | —Port-wine stains (PWS) | | —Lymphatic malformations | | • Vascular Tumors | | —Hemangiomas | | Nevus Sebaceous | Table 1. Neonatal Skin Lesions That Are Clues to More Serious Disorders This review describes some of the most commonly encountered, clinically significant birthmarks, emphasizing those findings that should prompt early assessment, diagnosis, and appropriate treatment and counseling. Hyperpigmented lesions are common at birth and in the first few postnatal weeks. They may be macular, papular, plaquelike, evenly colored, or speckled. ### Cafe Au Lait Macules Cafe au lait macules (CALMs) are localized epidermal melanocytic flat lesions that usually are round or oval, evenly colored with light brown pigmentation, have distinct margins, and range in size from a few millimeters to 15 to 20 cm in diameter. They can occur anywhere on the body, most often on the buttocks in newborns (Fig 1). Most CALMs are present at birth or develop in the first few postnatal months. They are seen in 0.3% to 18% of neonates and usually are not associated with specific abnormalities, although they can be markers for some genetic diseases, such as neurofibromatosis type 1 (NF-1). Neonates who have multiple CALMs …

Skin lesions in neonates

Skin lesions in neonates

Primary Cutaneous Aspergillosis in a Preterm Infant

A case of primary cutaneous aspergillosis in a very low birthweight infant that responded to medical therapy is reported. Knowledge of the potential pathogenic role of this organism in neonatal skin lesions is important because of resistance to standard empirical antibacterial therapy and the potential for dissemination and deep parenchymal invasion. Surgical excision may be necessary if cutaneous aspergillosis progresses despite systemic antifungal therapy.

Antiviral treatment of herpes simplex infection in neonates and pregnant women

Herpes simplex infections in neonates include (1) infections beginning in skin or mucous membranes, (2) infections of the central nervous system, and (3) disseminated herpes of the newborn. Early recognition of infections beginning in skin or mucous membranes is essential because 75% will disseminate internally if untreated. Skin lesions provide important diagnostic clues in herpes of the nervous system and disseminated herpes, but they often appear late and in only about 60% of infected neonates. Acyclovir and vidarabine are effective therapies but they must be administered early to prevent serious damage or death. Herpetic skin lesions in neonates may be confused with pyodermas. Direct immunofluorescence and cultures are reliable diagnostic tests. Congenital herpes may cause widespread skin involvement and multiple eye and nervous system diseases. The mother is the source of neonatal herpes in about two thirds of cases. Asymptomatic genital shedding of virus late in pregnancy does not accurately predict whether maternal cultures will be positive at the time of delivery. The risk of the infant acquiring neonatal herpes from a mother with recurrent herpes at birth is about 5%, but the risk is much higher if the mother has true primary genital infection.