1. January 11, 2011

13.  Most common ◦ Staphylococcus aureus  Other ◦ Listeria ◦ Strep species ◦ Pseudomonas aeruginosa ◦ Treponema pallidum ◦ Hib

14.  Newborns especially susceptible to the exfoliative toxins  Protein cleavage in desmosomes  Tense bullae ◦ Usually no longer intact by presentation

15.  Presentation ◦ 3-7 days ◦ Febrile ◦ Irritable ◦ Diffuse blanching erythema  Flaccid blisters 1-2d later  Mechanical stress  Nikolsky’s sign  Flaky desquamation ◦ May have conjunctivitis

16.  Work up ◦ Cultures  Blood  Urine  Nasopharynx  Umbilicus  Lesions ◦ Clinical Diagnosis  Biopsy may be done if TEN is suspected

17.  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

19.  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

22.  Days to weeks later  HSV  VZV  CMV  Coxsackieviruses

23.  Intrapartum exposure  Ascending infection ◦ May have intact membranes ◦ Postnatal inoculation may occur  Symptoms ◦ Days to 4 weeks

24.  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

26.  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

28.  3-4 weeks of age at the earliest  Infants ◦ Vesicles ◦ Pustules ◦ Crusting  Widespread ◦ Hands, feet and wrists  Including palms and soles

29.  Epidermolysis bullosa  Epidermolytic hyperkeratosis ◦ Bullous ichthyosis  Aplasia cutis congenita ◦ Congenital focal absence of the skin  Incontinentia pigmenti

30.  May present with blisters in the newborn