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Morning Report

Morning Report. January 11, 2011. Common Newborn R ashes. Vesiculobullous and Pustular lesions in the newborn. Bacterial Infections. Most common Staphylococcus aureus Other Listeria Strep species Pseudomonas aeruginosa Treponema pallidum Hib. Staph Scalded Skin Syndrome.

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Morning Report

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  1. Morning Report January 11, 2011

  2. Common Newborn Rashes

  3. Vesiculobullous and Pustular lesions in the newborn

  4. Bacterial Infections • Most common • Staphylococcus aureus • Other • Listeria • Strep species • Pseudomonas aeruginosa • Treponemapallidum • Hib

  5. Staph Scalded Skin Syndrome • Newborns especially susceptible to the exfoliative toxins • Protein cleavage in desmosomes • Tense bullae • Usually no longer intact by presentation

  6. Staph Scalded Skin Syndrome • Presentation • 3-7 days • Febrile • Irritable • Diffuse blanching erythema • Flaccid blisters 1-2d later • Mechanical stress • Nikolsky’s sign • Flaky desquamation • May have conjunctivitis

  7. Staph Scalded Skin Syndrome • Work up • Cultures • Blood • Urine • Nasopharynx • Umbilicus • Lesions • Clinical Diagnosis • Biopsy may be done if TEN is suspected

  8. Staph Scalded Skin Syndrome • 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

  9. Congenital Syphillis • 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

  10. Viral Infections • Days to weeks later • HSV • VZV • CMV • Coxsackieviruses

  11. Neonatal HSV • Intrapartum exposure • Ascending infection • May have intact membranes • Postnatal inoculation may occur • Symptoms • Days to 4 weeks

  12. Neonatal HSV • 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

  13. Fungal Infection • 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 cutaneouscandidiasis

  14. Scabies • 3-4 weeks of age at the earliest • Infants • Vesicles • Pustules • Crusting • Widespread • Hands, feet and wrists • Including palms and soles

  15. Congenital Disorders • Epidermolysisbullosa • Epidermolytic hyperkeratosis • Bullousichthyosis • Aplasia cutis congenita • Congenital focal absence of the skin • Incontinentiapigmenti

  16. CutaneousMastocytosis • May present with blisters in the newborn

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