January 11, 2011
Most common ◦ Staphylococcus aureus Other ◦ Listeria ◦ Strep species ◦ Pseudomonas aeruginosa ◦ Treponema pallidum ◦ Hib
Newborns especially susceptible to the exfoliative toxins Protein cleavage in desmosomes Tense bullae ◦ Usually no longer intact by presentation
Presentation ◦ 3-7 days ◦ Febrile ◦ Irritable ◦ Diffuse blanching erythema Flaccid blisters 1-2d later Mechanical stress Nikolsky’s sign Flaky desquamation ◦ May have conjunctivitis
Work up ◦ Cultures Blood Urine Nasopharynx Umbilicus Lesions ◦ Clinical Diagnosis Biopsy may be done if TEN is suspected
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
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
Days to weeks later HSV VZV CMV Coxsackieviruses
Intrapartum exposure Ascending infection ◦ May have intact membranes ◦ Postnatal inoculation may occur Symptoms ◦ Days to 4 weeks
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 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
3-4 weeks of age at the earliest Infants ◦ Vesicles ◦ Pustules ◦ Crusting Widespread ◦ Hands, feet and wrists Including palms and soles
Epidermolysis bullosa Epidermolytic hyperkeratosis ◦ Bullous ichthyosis Aplasia cutis congenita ◦ Congenital focal absence of the skin Incontinentia pigmenti
May present with blisters in the newborn