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|Staphylococcal Pustules||Paronychia||Bullous Impetigo|
|Generalised In Utero Skin Infection||Congenital Syphilis|
|The humble superficial pustule is making a comeback with more babies being infected. Typically, it is seen after few days of life, may affect any part of the body, but appears to have a predilection to the neck, axilla, and inguinal areas. It is almost always caused by Staphylococcus aureus. If one lesion is seen, it may be treated "expectantly" with application of chlorhexidine mainly to prevent spread. However, if more than one lesion exists, then a course of oral antibiotic is indicated after a culture is taken. For pustules in the periumbilical area, consider at least beginning the course with systemic antibiotics.|
Localised inflammation of the nail fold (paronychia) is relatively
common in infants. Before secondary infection (usually with
Staphylococcus aureus or Streptococcus pyogenes) occurs,
there is an initial separation of the skin from the nail fold.
This may be exacerbated by the baby sucking their fingers or by
overzealous trimming of the infant's finger nails.
Most often, the infection can be treated with oral or - in severe cases - intravenous antibiotics (our first line is usually flucloxacillin). Occasional infants may need drainage of large collections, which may be achieved by pushing the skin away from the nail fold.
For lesions that are chronic, consider Gram negative organisms or Candida as a potential cause.
||A skin infection typically caused by Staphylococcus aureus. Lesions tend to appear in the later part of the first week of life or into the second week. Any body site may be involved with predilection to the diaper area. The bullae are flaccid, containing straw coloured or turbid fluid, rupture easily leaving a moist denuded area. Healing occurs without scarring. Treatment with a systemic appropriate antibiotic should be instituted particularly for lesions around the umbilicus.|
Herpes simplex lesions may involve the skin, the mouth, or the eye and
when they do, they provide valuable clues to the possibility of
associated disseminated or CNS herpes. Typically the lesions develop by
the end of the first week or into the second week of life, as the virus
is acquired at the time of birth. However, there are exceptions to the
rule and occasionally lesions may be present at birth and presumably
such infants would have been exposed to the virus several days prior to
Typically, grouped vesicles may be seen, often in a linear distribution if affecting the limbs such as in this photo. If the vesicle is eroded, a shallow ulcer with an erythematous base may be noted as in the second photograph.
There may be associated lesions on the lips, similar to those of the "cold sore" in the adult.
Inflammation of the umbilical stump (omphalitis) most commonly occurs
after day 3. Typically the stump appears reddened and may be
oedematous, with or without an exudative discharge. There may be
signs of cellulitis ("cord flare") and, very rarely, fasciitis.
Infective organisms are variable, but S.aureus, S.pyogenes, and
Gram-negative organisms are common. It is important to
differentiate omphalitis (or funisitis - infection of the cord itself)
from other causes of serous or exudative umbilical discharges, such as a
persistent vitelline duct, umbilical papilloma, or urachal remnant.
Management should include a swab of the affected area for Gram-stain and culture, mainly to guide treatment. Antibiotics covering the likely organisms should be commenced. Very occasionally, infection is invasive and there can be involvement of the umbilical arteries or veins, with septic embolisation to other organs.
Although prolonged rupture of the amniotic membranes may result in
systemic fetal and neonatal infection, the infant to the left also had
generalised skin infection. Born at 25 weeks gestation, there was
a history of ruptured membranes for several days. At delivery, the
baby was very foul-smelling with skin which already had evidence of
infection. Cultures from skin swabs taken at delivery grew a
veritable menagerie of organisms, including Eschericia coli,
Group B streptococcus, Staphylococcus aureus, and Candida
albicans. The skin is desquamating and erythematous, with
evidence of fissuring.
After treatment with appropriate antimicrobial agents, there was complete healing of skin at discharge with no evidence of scarring.
Congenital syphilis (CS) is a rare occurrence in New Zealand, although
there are concerns that the reported rates of syphilis in the community
appear to be increasing (Azariah S. Is
syphilis resurgent in New Zealand in the 21st century? A case series of
infectious syphilis presenting to the Auckland Sexual Health Service.
Approximately 50% of newborns with CS are asymptomatic, and cutaneous findings are not present in all symptomatic babies. Dermatological findings are quite variable, although palmar/plantar, perioral, and anogenital regions are classically described as being involved. The images to the left demonstrate findings at birth in an affected infant, with a desquamating eruption that was widespread over the entire body. These lesions are extremely infectious. Lesions described with early disease include petechiae, haemorrhagic vesicles, bullae (pemphygis syphiliticus), and erythematous macular, papulosquamous, annular, or polymorphous eruptions. Because of the variable lesions and clinical symptoms seen with CS, it has frequently been termed "the great imitator", and it is important to consider alternative diagnoses or vesiculobullous diseases that involve the palms and soles.
Infants with CS may have extracutaneous findings such as hepatomegaly, low birth weight, thrombocytopenia, anaemia, jaundice, respiratory distress, osteochondritis, hydrops fetalis, meningitis, chorioretinitis, and pseudoparalysis. Older infants may present with "snuffles" (syphylitic rhinitis) which, in the early stages, may be mistaken for an upper respiratory tract infection.
Last edited November 29, 2011