Incidence of Vesicobullous and Erosive Disorders of Neonates: Where and How Much to Worry?

OBJECTIVE

To analyse the incidence of dermatoses in neonates, stress the importance of simple noninvasive diagnostic procedures with perspective to actual need of active intervention.

METHODS

Forty four neonates with vesicobullous lesions in Departments of Dermatology and Pediatrics were evaluated with respect to diagnosis, required treatments and follow ups.

RESULTS

Of the total 44 neonates, 29 were boys and 15 girls. Low birth weight (weight at birth less than 2,500 g as per WHO criteria) was seen in 19 neonates. Of the infectious dermatoses, most common were pyodermas. Four cases (9%) were diagnosed to be of staphylococcal pyoderma and impetigo and two cases each of Group A Streptococcal impetigo and neonatal tinea faciei (4.5% each), one case each of neonatal candidiasis, neonatal varicella/chickenpox and scabies (2.3% each) were seen. Of the transient skin lesions, erythema toxicum neonatorum was commonest of all, being seen in 18 neonates (41%), followed by four cases (9%) of miliaria crystallina, three cases of neonatal acne (6.8%) and two cases of sucking blisters (4.5%) and one case each of transient neonatal pustular melanosis, epidermolysis bullosa simplex, incontinentia pigmentii, eosinophilic pustular folliculitis, pemphigus vulgaris and neonatal herpes simplex (2.3% each) were enrolled in this study (Fig. 1). Fig. 1 Piechart showing percentage and number of neonates with different diagnostic profiles in the study CONCLUSIONS: Certain specific considerations have to be born in mind while evaluating and managing neonatal dermatoses. Care has to be instituted to identify accurately infectious diseases and distinguish them from benign transient neonatal dermatoses. Some disorders first manifesting during the neonatal period may also represent harbingers of potential problems during adulthood. Finally, treatment modalities are instituted taking in account the actual diagnosis and judging if the treatment really is required or not.

Lymph node abscess and cardiac involvement in a patient with nodular lepromatous leprosy (LL) with erythema nodosum leprosum (ENL): a rare occurrence

With the world's focus on reducing the leprosy patient load to the extent of elimination, finding and reporting the rarer presentations of leprosy becomes important for prompt treatment. Also, these untreated patients may serve as a potential source of infection in community. We report a 35-year old man diagnosed to have lepromatous leprosy and erythema nodosum leprosum with inguinal lymph node abscess and suspected cardiac involvement that proved fatal. We stress the importance of detailed workup to look for associated systemic involvement for timely intervention and favourable outcome.

Ectopia cilia with pedigree analysis: Second case report in the world

We present a case of ectopia cilia in a 28-year-old male patient. Ectopia cilia was were seen in the outer third of left upper eyelid. The patient's maternal grandfather also had ectopia cilia of the left upper eyelid as reported by the patient's mother. Ectopia cilia is a rare condition seen in humans. Only 12 cases of ectopic cilia in humans have been reported so far in the world. The present case of ectopia cilia is the second case report in the world with pedigree analysis.

Lupus vulgaris in a young girl

With the estimated global burden of TB being 8.8 million incident cases and 1.1 million deaths from TB in HIV-negative cases and additional 0.35 million deaths in HIV-associated cases,1 the total number of cutaneous TB cases ( < 1-2 % of total cases) becomes significant. With the WHO setting up public-private mix partnerships and a millenium development goal of a 50% reduction in the total number of incident cases, the case detection and reporting of unusual cutaneous TB cases becomes very important. We present a case of lupus vulgaris in a young girl with rapid progression of a large plaque with hypertrophic features in the periphery. The case is unusual due to its rapid progression, unusual site and extensive giant form which have never been reported previously.

Cadmium and hypertension

Hypertension is a very common and important disease of modern civilised life. There are comflicting reports about cadmium, a trace element in the genesis of essential hypertension. The present study was conducted to estimate the cadmium levels in whole blood in the normal group of thirty subjects who were normotensive and the same was compared to that of thirty hypertensive patients and the levels were found to be statistically significant (p < 0.05).

Circadian rhythm in acute stroke

Ischemic events have been reported to follow a circadian rhythm. The frequency of myocardial infarction is found to be increased between 6:01 a.m. and 2:00 p.m. Blood pressure also demonstrates a similar circadian variation. Circadian variation of stroke onset has also been reported, but with contradictory findings. To determine this in the Indian population, we studied 182 consecutive patients of acute stroke admitted to our words within twelve hours of onset. The frequency of onset of stroke was found to be highest between 6:01 am and 2:00 pm, in patients of infarct as well as haemorrhage. Patients of hypertension also showed a similar variation. Thus, the identification of periods of high risk, may help by matching drug doses with periods of vulnerability.

Porencephalic cyst

Porencephalic cyst with seizure is rare. It represents a part of diffuse cerebral maldevelopment. Porencephaly occurs as a result of imbalance between brain growth and its vascular supply and is picked up by CT scan.

Facial nerve involvement in pseudotumor cerebri

A woman with history of bifrontal headache, vomiting and loss of vision was diagnosed as a case of pseudotumor cerebri based on clinical and MRI findings. Bilateral abducens and facial nerve palsies were detected. Pseudotumor cerebri in this patient was not associated with any other illness or related to drug therapy. Treatment was given to lower the raised intracranial pressure to which the patient responded.