Vesicular, Bullous And Pustular Lesions In The Neonates:

Kandel Hussein El-asfar

- 16’1 -SUMMARY A.OCO.CLUSIOMSVesicular, bullous and puc t.u l a r lesions inthe neonatal period, are common presentations tothe pediatritian. These lesions may hide an underlyig serious cause which may be life threatening.This work was done in order to study caref’uLlly all cases of these lesions, in regard totheir incidence, clinical manifestations, histopathologicalfindings in some selected ca s es andthe broad lines of diagnosis.This study involved fifty neonatal cases ofboth sexes (35 males and 15 females). They weresele ted from the pediatric department and outpatint pediatric and dermatologic clinics ofZaga ig University Hospitals.All cases were subjected to full historyinc I ding personal, present, past, family anddiet ry history as well as clinical examination.The laboratory investigations included stainingfor fungi by KOH stain, for bacteria by Gramstai- and for whit-e--blood cells by Giemsa stain~-- -- -----~-~- +---- 16z. -as w 11 as histopathological examination of 6selec ed cases by Haematoxylin and eosin stainthe c inical and laboratory investigations revealed11 ca es of miliaria (8 cases of miliaria crysta-11 na and 3 cases of miliaria r-ubr-a ) •9 ca es of erythema toxicum neonatorum.8 ca es of candidiases.6 CZl es of Periporitis st~~h)logens5 ca es of impetigo neonatorum.5 ca es of primary irritant contact dermatitis.2 ca es of acne neonatorum.ca e of drug eruption.1 ca e of sucking blister.ca e of transient neonatal pustular melanosis.rom the above we can notice that somecause a.”-e dangerous and similar to the self-limitingones .. Therefore, it is essential that every caseof ne natal vesicular, bullous or pustular lesionmust e examined carefuly, clinicaly and microscopially in order to reach to an acurate diagnosisso as to follow the appropriate lines oftreat- 16’3 -F rty percent of our cases were due to infection. The bad hygenic conditions in our communitymay play an important rule in this respect.Impr vement of the hygenic habi ts must be ouraim.St phylococal infection was found in 3/4 ofall infections, therefore, antistreptococcalant t bt ot.i cs (e.g. methicillin, nafcillin, oxacillinand others). Must be the first choice fortreat ng bacterial infections.Th s study showed a high incidence of miliaria,the hot and humid weather in our country is aperpi uating factor. Regulation of ambient temperatur (i f possible) often prevents miliaria andwe ad ice to change frequently wet clothes.This study showed a low incidence of erythemetoxicum neonatorum (18%), perhaps due to the lowbirth eight and the difficulty of recognition innon wh”te neonates.As or infection by candida albicans (congenitala d neonatal) ,prophylaxis by treating the- 1~’rinfeced pregnant women is very important especiallif we know that intrauterin death or soonafter labour may occur as acomplication of congenitaltype.Te percentirrit nt contactof cases suffereddermaitis whichfrom primaryis caused byprolo ged contact between the delicate neonatalskin and irritants especially stool, urine,saliv and milk. Proper cleaning of the neonatalskin ·s essential. This needs educational programsfor m thers to keep hygenic conditions.In spite of the fact that epidermolysis bullosais a are condition and no case could be find inthis study, a very simple test (Nikolysky’stest) must be done to exclude it when suspected.In cases of junctional epidermolysis buLl os a ,parent should be told that with each pregnancythere is a one in four chance that the chi Ld rnayct ed, This may be an indication for sterilizatin.Cases of recessive dystrophicbUllosa must be followed up,stricture and flexion contractureoccur in childhood age.epidermolysisas oesophagealof joints mayThe simplest method of preventing herpesinfect”on in the neonate, of course, is to deliverall p egnant women with known genital herpesinfect” on by casserian section. This approach iseffect” ve if the membrane is intact. In cases ofsuspec ed foetal infection, amnia centesis ishelpfu if the virus is recovered from amnioticfluid, caeserian section is no longer’ beneficial.In cases of pachyonychia congeni ta, oralleukok ra tosis should be evaluated periodically,since alignant changes may occur as early as the2nd de ade of life.Alt ough transient neonatal pustular melanosiswas fi st described by Rammamurthy (1916), it isnot a very rare disorder, as one case was foundin thi study.