Bullous eruption on the back of both hands in a newborn

Abstract

The 9-days-old, fully breastfed girl consulted the emergency room with skin lesions on the back of both hands, which were present since birth. The birth was without problems and the newborn screening was inconspicuous. During the postnatal period no fever occurred. Other newborns of the same days did not show similar skin lesions. Neither a direct contact to plants nor an increased exposition to UV light could be identified. The mother suffered from pruritic skin irritations with redness on the abdomen, which she firstly detected 4 weeks before, and which after birth spreaded over the trunk and extremities. Local treatment with a methylprednisolone aceponat-containing lotion did not achieve adequate improvement. Skin findingsOn the back of both hands and on the proximal extensor sides of the fingers pale erythema with multiple blisters containing a serous fluid (Figure 1a, b). The oral mucosa as well as the external genitals did not show any anomalies. The general condition of the baby was not affected.

Infantile bullous pemphigoid with “string of pearls sign”

“…The differential diagnosis of bullous diseases in the pediatric years is broad, ranging from infectious to genetically determined blistering disorders [1]. Regarding acquired immunobullous diseases, they are extremely rare in newborns, and when present, are usually caused by the transplacental passage of autoantibodies (pemphigoid gestationis), [1,2].…”