|Year : 1991 | Volume
| Issue : 1 | Page : 25-28
Prevalence of dermatoses in the neonates in Pondichery
CM Baruah, V Bhat, Rohit Bhargava, RB Garg, Ku
C M Baruah
Source of Support: None, Conflict of Interest: None
This study records the preliminary observation on neonatal dermatoses in relation to sex, birth weight and gestational age in 500 newborns delivered between August 1986 and September 1987 at JIPMER Hospital, Pondichery, Physiological dermatoses seen in 100% of the newborns, in the order of frequency were : linea nigra, Epstein's pearls, physiological scaling, milia and erythema toxicum. Salmon patches were the commonest vascular birthmarks (34.6%) Twenty-three per cent had transient neonatal angioma, an entity not described earlier. Infectious dermatoses observed were pyoderma (3%), staphylococcal scalded skin syndrome, congenital syphilis, congenital candidiasis and a case of tinea corporis, probably the youngest described in literature. The commonest congenital malformation of the skin was absence of the outer fold of the helix (3.5%). An unusual case of aplasia cutis involving the scalp and both flanks associated with bilateral corneal opacities was observed.
Keywords: Dermatoses, Neonates, Transient neonatal angioma, Aplasia cutis
|How to cite this article:|
Baruah C M, Bhat V, Bhargava R, Garg R B, Ku. Prevalence of dermatoses in the neonates in Pondichery. Indian J Dermatol Venereol Leprol 1991;57:25-8
|How to cite this URL:|
Baruah C M, Bhat V, Bhargava R, Garg R B, Ku. Prevalence of dermatoses in the neonates in Pondichery. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2020 Feb 22];57:25-8. Available from: http://www.ijdvl.com/text.asp?1991/57/1/25/3613
Majority of the newborn dermatoses are usually physiological and transient. Certain conditions appear as birthmarks. Nevertheless, these often cause anxiety and serious concern to the parents.  The available literature on neonatal dermatoses in our country is meager.  Only a few reports are available in the literature , The present study was undertaken with a view to study. the pattern of neonatal dermatoses in this part of the country.
| Materials and Methods|| |
A total of 500 neonates born in this hospital during August 1986 to September 1987 were selected at random and examined. A thorough whole body scanning of each neonate was performed jointly by a dermatologist and a pediatrician as soon as the infants recovered from the stress of labour and delivery. Diagnostic criteria adopted for dermatoses were as outlined by Atherton et al  The observations were recorded in a pre-set proforma. Most newborns were followed up daily for a minimum of 3 days and a maximum of 30 days.
| Results|| |
Out of 3,551 neonates born and registered in the hospital during the study period, a total of 500 (14.08%) neonates (275 males and 225 females) were examined. The spectrum of dermatoses observed in these neonates is shown in [Table - 1].
Physiological scaling [Table - 1][Table 9]
Eighty-three per cent had scaling by the 14th day. Peak scaling was between third and sixth days and regressed by the end of the second week. Scales were easily removable, fine and thin, on a non-erythematous base. Sites involved were trunk, extremities, head and neck especially the forehead. No sex predilection was detected.
Linea nigra [Table - 1],[Table 6] :
It was seen in 88% of cases. Pigmentation of the line between symphysis pubis and umbilicus varied from a barely discernible brown to dark brown in colour, the lower one-third of the line being more prominent. In all cases, the line persisted during follow up.
Epstein pearls [Table - 1],[Table 2]
These were observed in 86% of neonates on the first day of birth as pearly white papules 1-3 mm size on the hard and soft palate. Most pearls disappeared within 3-4 weeks after birth (Mean time 20 days). No difference in incidence between pre and full term infants was observed.
Erythema toxicum neonatorum [Table - 1],[Table 4]
It was seen in 34.8% cases. In 93.1% the lesions appeared in the first 72 hours and in only 6.9% after 72 hours. The incidence was less in neonates with a lower birth weight. Out of 174 cases, 132 (76%) had macules, 69 (40%) had maculopapules and 11 (6.3%) had pustules. The sites involved were cheeks, upper trunk, buttocks, thighs and arms. Palms and soles were always spared.
Milia [Table - 1],[Table 3] :
Milia were seen in 93.1% (393/422) neonates in the first 72 hours of birth. The common sites involved were chin 29 (7.4%), cheeks and nasolabial folds 125 (31.8%), tip of nose 373 (96.2%), forehead 86 (21.9%), alae nasi 245 (62.3%), philtrum 21 (5.3%). Majority had involvement of more than one site. The maximum incidence was in the gestational age of 37 weeks (96.7%). It was more in relation to birth weight, especially in those weighing 2500 gms or more (95.5%).
Miliaria [Table - 1],[Table 8]
The incidence observed was 66 out of 500 (13.2%). Of these, 48 (72.7%) were miliaria rubra and 18 (27.3%) M. Crystallina, 12 out of which were seen in pre-term babies. Multiple sites were commonly involved, like neck, flexures, axillae, chest, groin in M. rubra, forehead, neck, flexures and groin in M. crystallina. The lesions subsided in 3-5 days. Sterile pustules were seen in 6 cases of M. rubra. None of M. crystallina cases evolved into pustules.
Vascular birth marks observed were salmon patch, transient neonatal angioma and hemangioma. Salmon patches were seen in 34.6% neonates [Table - 1],[Table 5]. Patches were pink macules with diffuse edge having visible fine linear telangiectatic vessels on the surface. Sites involved were, neck 29 (23%), upper eyelid 144 (84.5%) and glabella 28 (16.2%). All lesions were present at birth and persisted. There were no sex, weight or gestational age variations.
Transient neonatal angioma was observed as well defined red macules, 2-3 mm in size, in 23% of the neonates examined during the first week. There was no site predilection. The number varied from 1 to 10 and in average 3 to 4 spots. Evolution of lesions was observed in 78 neonates in a two week follow up period. In 73% neonates, the spots faded by 1st week and in 27% by the end of 2nd week. Raised haemangioma was seen in only one patient. pigmented birthmarks observed were Mongolian spots (78.4%), cafe' aulait spots (7.8%), melanocytic naevi (0.8%) and one naevus achromics.
The only chronic skin condition observed in this study was junctional epidermolysis bullosa in a seven day old child who succumbed to septicemia. The infective conditions observed were : neonatal pyoderma (3%), staphylococcal scalded skin syndrome, congenital syphilis, tinea corporis and congenital candidiasis, one each.
None of the neonatal pyoderma patients had signs suggestive of septicemia. It was observed that pre-terms were most prone to neonatal pyoderma (22.2%) as compared to full term babies. All smears showed presence of gram positive cocci. The sites observed in the order of frequency were neck, groin, axillae, buttocks, cubital fossae and scalp.
Congenital candidiasis : A hospital born male baby, examined within 24 hours of birth, had discrete pustules all over the body including palms and soles, sparing the scalp and genitalia and was free of constitutional signs and symptoms. A smear from pustule revealed candida and was confirmed by culture. Blood culture was negative for candida. The solitary patient of corporis, proved by the scraping KOH microscopy and by culture, was a 16- day -old female child who had typical annular patches on face and chest and whose mother also had tinea corporis. Congenital malformations involving the skin are shown in [Table - 1].
| Discussion|| |
In this study all the 500 newborns examined, revealed either one or the other form of physiological dermatoses mentioned in the textbooks. Pre-term neonates exhibited a lower incidence of physiological scaling, milia, Epstein's pearls and erythema toxicum, though the incidence of infection was higher than in the full-term neonates. The physiological dermatoses observed in the order of frequency were milia (93.1%), linea nigra (88%) and erythema toxicum neonatorum (34.8%). The only other Indian study  available compares well with our observations on evolution of the lesions and their relationship to gestational age and birth weight, but the prevalence differ slightly probably due to our random sampling of neonates.
Of the transient neonatal dermatoses, miliaria was observed in 13.2% neonates. M. rubra was more common than M. crystallina. Ten per cent cases evolved into sterile pustules. No comparable figures are available in literature.
Transient neonatal angioma has not been previously described and a review of literature did not reveal any diagnosis that could fit in with this clinical picture, except the telangiectasia described in the Indian study. 
Three per cent neonates in our study had pyoderma comparable to 4.2% by Nellian.  Staphylococcal scalded skin syndrome was seen in only one case where the lesions started as bullous impetigo and later evolved into ssss.
The single neonate with tinea corporis seen in our study is highlighted as no such case in a newborn has been described so far. Both the mother and the neonate were successfully treated with topical antifungal. Congenital candidiasis is rare (0.2%) in our study, compared to 1% reported by Schachner. sub The lesions healed with topical application of 1% Gentian violet paint.
Of the congenital malformations, absence of the outer fold of helix was seen in 2.8% neonates in this study as compared to 3.5% reported by Weston.  Other ear abnormalities seen were atresia of the external ear and accessory tragi.
Aplasia cutis [Figure - 1][Figure - 2] is a rare condition occurring in 1/3000 cases.  The only case seen in our study was interesting, having bilateral flank lesion associated with scalp lesions and bilateral corneal opacities. The flank lesions had healed in utero and presented at birth as papery atrophic scars. The exact incidence of bilateral flank lesions is not known.
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|3.||Julia MA, James SA and Frank OA : The whole pediatrician catalog, vol 2, W B Saunders, Philadelphia, 1979; p 153-154. |
|4.||Hodgeman JE, Freedman RI and Levan NE : Neonatal dermatology, paediat Clinics N America, 1971; 18 : 713-838. |
|5.||Atherton DJ and Rook A : The newborn, in : Textbook of Dermatology, 4th ed, Editors, Rook A, Wilkinson DS and Ebling FJG : Blackwell Scientific Publications, London, 1987; p 229-264. |
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[Figure - 1], [Figure - 2]
[Table - 1]
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