january 11, 2011. most common ◦ staphylococcus aureus other ◦ listeria ◦ strep species ◦...
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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