Atypical erythema toxicum neonatorum of delayed onset in a term infant

The role of eosinophils in the differential diagnosis of inflammatory skin diseases

Eosinophils are known to be present in inflammatory skin diseases, but their diagnostic utility is not well established. Upon review of the published status of lesional eosinophils, several categories were identified. 1) Lesional eosinophils highly characteristic such that, in their absence, the pathologist may question the diagnosis. These include arthropod bite reactions and scabies, urticarial dermatitis, and other eosinophilic dermatoses. 2) Lesional eosinophils rare or absent, such that, in their presence, the pathologist may question the diagnosis. These include pityriasis lichenoides, graft versus host disease, and connective tissue disorders. 3) Lesional eosinophils variable and, while in some cases expected, are not required for diagnosis. These include drug reactions, atopic dermatitis and allergic contact dermatitis. 4) Lesional eosinophils variable and not expected but may be seen to a limited extent. These include lichen planus and psoriasis.

Oral mucosal and skin lesions observed in the first 48 hr in newborns

BACKGROUND

Newborn period is a definition used for the first 4 weeks of life and it has some different characteristics compared with adult skin.

AIMS

In this study, we tried to define the pathological and physiological skin manifestations and demographic data observed in newborns PATIENTS/METHODS: In this study, newborns born between 2018 and 2019 were evaluated prospectively. Along with demographic findings, temporary neonatal skin manifestations, congenital spots, benign neonatal pustulosis, congenital anomalies and other lesions were statistically evaluated.

RESULTS

A total of 2109 newborns, consisting of 1157 (54.9%) boys and 952 (45.1%) girls, were enrolled in the study. 94% of the newborns evaluated had at least one skin lesion. The most common skin manifestations in the study were Epstein pearls at a rate of 49.4%. This was followed by salmon patch (38.4%), Mongolian spot (20.1%), edema in the eyelids (15.5%), lanugo (15.4%), and erythema toxicum neonatarum (11.6%), respectively.

CONCLUSION

Several studies on dermatological findings observed in newborns have been conducted in many different countries around the world. In this study, we tried to identify many temporary and pathological skin manifestations and congenital anomalies observed in the first 48 h in newborns.

Epidemiology and Predisposing Factors for Erythema Toxicum Neonatorum and Transient Neonatal Pustular: A Multicenter Study

BACKGROUND/OBJECTIVES

Erythema toxicum neonatorum (ETN) and transient neonatal pustular melanosis (TNPM) are benign pustular skin conditions that are relatively common in newborns, but the predisposing factors for these conditions are unknown. Our goal was to verify the prevalence of ETN and TNPM and their predisposing factors in a large sample of neonates.

METHODS

In this prospective 1-year multicenter study, 2,831 neonates (age ≤72 hours) born in southern Brazil were randomized to undergo skin examination by a dermatologist.

RESULTS

Most were Caucasian (of European descent). There were 602 cases of ETN (21.3% prevalence) and 97 cases of TNPM (3.4% prevalence). ETN was more prevalent in Caucasian neonates, male neonates, those with 1-minute Apgar scores from 8 to 10, those who had no gestational risk factors, and those not admitted to a neonatal intensive care unit (NICU). Positive correlations were observed between ETN and gestational age and birthweight. ETN was least frequent in the winter. No NICU admission or birth during the spring was associated with TNPM.

CONCLUSIONS

At least in the region where this study was conducted, seasonality affects these benign pustular skin conditions. The health of the child at birth, gestational age, and birthweight influenced the development of ETN. This finding may indicate a role of immune system maturity in ETN, but additional studies are needed to confirm this.

Benign skin disease with pustules in the newborn

The neonatal period comprises the first four weeks of life. It is a period of adaptation where the skin often presents several changes: transient lesions, resulting from a physiological response, others as a consequence of transient diseases and some as markers of severe disorders. The presence of pustules in the skin of the newborn is always a reason for the family and for the assisting doctor to be worried, since the newborn is especially vulnerable to bacterial, viral or fungal infection. However, the majority of neonatal skin pustules is not infectious, comprising the benign neonatal pustulosis. Benign neonatal pustuloses are a group of clinical disease characterized by pustular eruptions in which a contagious agent is not responsible for its etiology. The most common ones are erythema toxicum neonatorum, the transient neonatal pustular melanosis and the benign cephalic pustulosis. These dermatoses are usually benign, asymptomatic and self-limited. It is important that the dermatologist and the neonatologist can identify benign and transient lesions, those caused by genodermatoses, and especially differentiate between neonates with systemic involvement from those with benign skin lesions, avoiding unnecessary diagnostic tests and worries.

Birthmarks and Transient Skin Lesions in Newborns and Their Relationship to Maternal Factors: A Preliminary Report from Northern Italy

BACKGROUND

A total of 620 healthy term neonates, randomly selected among babies born at the San Paolo Hospital in Milan (Italy), were examined to study the relationship between birthmarks and transient cutaneous lesions in newborns of different ethnic groups.

METHODS

Information on sociodemographic factors and on physiopathological variables of the pregnancy was collected. Multiple logistic analyses were performed to assess associations between diagnosed skin lesions and various factors. Odds ratios (OR) as a measure of association and the corresponding 95% confidence intervals were estimated.

RESULTS

A positive association was found between reduced hypoderm and pregnancy illness (OR = 2.78), hypertrophy genitalia and use of drugs (OR = 1.86) and illnesses in pregnancy (OR = 1.61). Hyperpigmentation in the genital area and Mongolian spot showed significant positive association with geographical area of origin, being systematically more frequent in non-European neonates, while for melanocytic congenital nevi a positive association was observed only for Asiatic newborns (OR = 4.67); salmon patch on the nape showed a significant OR of 1.81 among mothers aged > or = 35.

CONCLUSIONS

Significant associations between some sociodemographic factors and cutaneous lesions of the newborn and anamnestic data related to the pregnancy were found. Dermatologic conditions are common in the newborns and may justify dermatologic examination.

Erupções vesicopustulosas benignas no neonato

As erupções vesicopustulosas neonatais compreendem um grupo de desordens que surgem nas primeiras quatro semanas de vida. Apresentam extensa relação de diagnósticos diferenciais e, na maioria das vezes, podem ser identificadas clinicamente ou mediante recursos laboratoriais simples. Os dermatologistas devem reconhecer esses quadros cutâneos e, sobretudo, saber diferenciá-los de outras dermatoses graves e potencialmente fatais.