Analytical Study of Pustular Eruptions in Neonates

Abstract

Pustular eruptions are commonly encountered in neonatal practice. Much confusion exists among clinicians because of the similarity in clinical lesions, paucity of relevant literature, and varied nomenclature used for these diseases. This often results in inappropriate diagnoses and therapies, besides subjecting the neonates to invasive and traumatic investigative procedures. We conducted a comprehensive study of pustular eruptions in 100 neonates, using the clinical examination and simple laboratory tests to arrive at a practical diagnostic and therapeutic approach to this problem. Of the 100 neonates with pustular eruptions, 36% were in the early neonatal period (first week of life). A slight male preponderance with a male:female ratio of 1:0.79 was observed. The majority of the families of these infants had poor socioeconomic status (96%) and were living in slums (71%). A study of their educational status revealed that 54% of the mothers were uneducated. Fifty-seven percent of the neonates were born at home. The clinical pattern of diseases among these neonates was that 58% of them had infections [impetigo (23%), intertrigo (14%), scabies (6%), and viral diseases (6%)]. Noninfectious diseases (42%) included miliaria pustulosa, erythema toxicum neonatorum, epidermolysis bullosa, and contact dermatitis. Simple laboratory investigations helpful in establishing the diagnosis were smears processed with Gram (24%) and Giemsa (39%) stains and wet mounts with 10% potassium hydroxide (KOH) solution (27%) for direct microscopic examination. More than half (53%) of the patients required no specific treatment except for counseling and medications to alleviate symptoms, while others with an infectious etiology responded to topical and or systemic antibiotics/antifungals. Pustular eruptions in neonates include both infectious and noninfectious diseases. Simple laboratory tests such as Gram- and Giemsa-stained smears, direct microscopy with 10% KOH wet mounts, bacterial and fungal cultures are helpful in establishing the diagnosis and occasionally skin biopsy is needed. A practical diagnostic and therapeutic approach to this problem is discussed.

Infantile Eczema at One Month of Age Is Associated with Cord Blood Eosinophilia and Subsequent Development of Atopic Dermatitis and Wheezing Illness until Two Years of Age

“…Infection with Malassezia furfur [23] and Pityrosporum ovale [24] or the abnormal metabolism of essential fatty acids [25] are implicated in the pathogenesis of seborrheic dermatitis. Hypersecretion of sweat and sebum may facilitate infection with Staphylococcus aureus [2] , Streptococcus [3] and fungi [4] and participate in the pathogenesis of intertrigo. Frequent urination and bowel movements as well as the use of diapers are causative for the onset of diaper dermatitis [5,6] .…”

“…Physiological and pathological skin eruptions including infantile eczema [1] , seborrheic dermatitis, intertrigo [2][3][4] and diaper dermatitis [5,6] are common in neonates and are often presented to the general practitioner as either a primary or incidental problem at consultation [7] . Some of these skin disorders are improved naturally or upon treatment, but some persist for a long time with a repetitive cycle of minor relapse and improvement.…”

Generalised staphylococcal pustulosis in a neonate: A case report

“…The structural immaturity of neonatal skin often results in atypical and ambiguous skin symptoms and signs, thus the similarity of clinical features, immaturity of skin and lack of relevant literature increases the diagnostic difficulty in cases of neonatal pustular lesions. 5 Of the benign transient neonatal skin lesions, erythema toxicum neonatorum is commonest of all. 6 Erythema toxicum neonatorum presents as erythematous macules, papules, and pustules on the face, trunk, and limbs, typically it resolves spontaneously in a week.…”

Scabies in a 2-month-old Infant Successfully Treated with Lindane

“…Ten to twenty percent of patients require retreatment in 7∼10 days. An alternative therapy for newborns is the application of 5% to 10% precipitated sulfur in petrolatum 6 . Permethrin has less neurotoxicity than lindane, particularly in children, and is therefore preferred in North America.…”