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ORIGINAL ARTICLE
Year : 2000  |  Volume : 66  |  Issue : 1  |  Page : 26-28

Clinico epidemiological study of cutaneous manifestations in the neonate




Correspondence Address:
K Dash


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Source of Support: None, Conflict of Interest: None


PMID: 20877015

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How to cite this article:
Dash K, Grover S, Radhakrishnan S, Vani M. Clinico epidemiological study of cutaneous manifestations in the neonate. Indian J Dermatol Venereol Leprol 2000;66:26-8

How to cite this URL:
Dash K, Grover S, Radhakrishnan S, Vani M. Clinico epidemiological study of cutaneous manifestations in the neonate. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Oct 20];66:26-8. Available from: http://www.ijdvl.com/text.asp?2000/66/1/26/4855



  Introduction Top


The skin of the infant differs from that of the adult, in that it is thinner, less heavy, has weaker intercellular attachments and produces fewer sweat and sebaceous gland secretions. Although much has been reported on the various disorders peculiar to the skin of infants, very little is known about variations and activity of the skin in neonates. In view of this a study was conducted to analyse the clinical spectrum and epidemiological characteristics of neonatal skin.


  Materials and Methods Top


A study of 100 neonates was carried out in the neonatal ward of Command Hospital, Airforce Bangalore for a period of one year from March 1997 to March 1998.

A detailed history of the neonates age, sex, maturity, birth weight, significant maternal history and mode of delivery was elicited. General physical and systemic examination of all neonates were undertaken. An exhaustive dermatological examination was conducted to record physiological and pathological manifestations in neonatal skin. Spe­cial emphasis was laid on simple non invasive labo­ratory investigations such as scraping for candida, pus swabs for bacterial culture, smears from pustules for grams stain, as indicated.


  Results Top


Of the 100 neonates examined there were 54 males and 46 females, the male to female ratio being 1:0.85. Birth weight of the neonates ranged from a minimum of 1.1 Kg to maximum of 4 kg. 92 (92%) were full term and 8 (8%) were preterm (<36 completed weeks of gestation).

The non- infective skin conditions observed are given in [Table - 1]. Epstein pearls, lanugo hair, icterus, perianal dermatitis and cradle cap were found in high percentage in preterm neonates. Infections were found in 5 (5%) neonates comprising of oral thrush in 1 (1%), cutaneous candidiasis in 2 (2%) and omphalitis in 2 (2%). Melanocytic naevi were found in 2 (2%), naevus achromicus in 1 (1%), portwine stain in 1 (1%) cafe au lait macules in 2 (2%) and piebaldism in 1 (1%) neonates respectively.


  Discussion Top


Among the various cutaneous disorders the most common skin manifestation noted was Mongolian spots in 89 neonates (89%). Majority were found over lumbosacral region (83%). The incidence of Mongolian spots reported varied from 56% to 98% in various studies. [1],[2],[3],[4],[5] Its incidence in Asiatic new born was found to be 81% in one study.[1] It is evident that greater the degree of natural pigmentation, the higher is the occurrance of Mongolian spots in the new born.[6]

The second most common condition noted was Epstein pearls (38%). There were no preputial pearls. The incidence of Epstein pearls varied from 43% to 64.3% in various studies and was more common among whites. [3],[4],[7] This explains its lower incidence in our study. Twenty-seven neonates (27%) had erythema toxicum in our study. The reported incidence varied from 4.5% to 72% in other studies.[3],[4],[5],[6]It is a transient adjustment reaction.[8] An important observation was that none of our pre- term neonates had this condition. Its low incidence in pre­term neonates, as seen in other studies[5] could be due to immunological immaturity of the neonatal skin responses.

Miliria was found in 24 newborns in our study. The incidence varied from 4.4% to 50% in other studies.[3],[5],[9] It is postulated that the presence of hypertonic sodium chloride in the skin may be a factor in the etiology of naturally occurring miliaria and it might be a manifestation of faulty adaptation to climate in this geographical region. No preterm neonates had miliaria in our study. This could be due to the immaturity of cutaneous response to the enviromental factors.

Sebaceous hyperplasia was noted in 22 neonates. As a manifestation of maternal androgen stimulation, these represent a temporary disorder that resolve spontaneously in first few weeks of life. [11] An incidence of 53.2% was noted in a previous study.' A notable observation was absence of this condition in preterm neonates.

Of our neonates, 13% had milia. A varied incidence of 4.2% to 94.8% has been reported in various studies.[2], [3] Cutis marmorata was found in only 1 neonate. This phenomenon is a physiologic response to chilling resulting in dilatation of capillaries and small venules. Usually it dissappears as the infant is rewarmed.[11] One study has reported a high incidence (43.6%) of this disorder in neonates.[3]

Physiologic scaling of new born was noted in 15 (15%) of neonates which is in concordance with the incidence reported in other studies. [3],[4] Lanugo hair was present in 7 (7%) of neonates. A higher percentage was noted among premature babies (75%) than full term. Icterus was found in 20 (20%) of neonates. Predictably a high percent of them were premature (75%) as reported in another study.[3] Perianal dermatitis occurred in 3; higher incidence was found in premature neonates (25%) as compared to full term (1.08%). Similar incidence (27.8%) has been reported in a large study.[5] Our findings differ from others in that these neonates were all breast fed and not formula fed, though the latter have reportedly higher incidence of perianal dermatitis. [12] This is in some way related to ammoniacal stools produced by the neonates. [13] It is not clear if pre term neonates produce more alkaline stools than full term neonates. The incidence of oral thrush, cutaneous candidiasis and omphalitis in our study correlates with those in another large study[3]. The incidence of cafe au lait macules and congenital melanocytic neavi in our study correlated with those in other studies. [3],[4],[5],[6],[14]

 
  References Top

1.Kahana M, Feldman M, Abudi Z, et al. The incidence of birth marks in Israeli neonates. Int J Dermatol 1995; 34: 704-706.  Back to cited text no. 1  [PUBMED]  
2.Mishra PC, Mathur GP, Mathur S, et al. Normal anatomic variants in the new born. Indian Pediatrics 1992; 58: 69-72.  Back to cited text no. 2    
3.Nobbay B, Chakrabarty N. Cutaneous manifestations in the new born. Indian 3 Dermatol Venereol Leprol 1992; 58:69-72.  Back to cited text no. 3    
4.Kulkarni ML, Singh R. Normal variants of skin in neonates. Indian J Dermatol Venereol Leprol 1996;62: 83-86.  Back to cited text no. 4    
5.Saraeli T, Kenny Jr. 3, Scott RB. Common skin disorders in the new born Negro infant. Pediatr 1963; 62: 358-362.  Back to cited text no. 5    
6.Jacobs AH, Walton RG. The incidence of birthmarks in neonates. Pediatrics 1976; 58: 218 - 222.  Back to cited text no. 6  [PUBMED]  
7.Jorgenson RJ, Shapiro SD, Salinas CF, et al. Intraoral findings and anomalies in neonates. Pediatrics 1982; 69: 577-581.  Back to cited text no. 7  [PUBMED]  
8.Keital HG, Yadav V. Etiology of toxic erythema. Am 3 Dis Child 1963; 106: 366-367.  Back to cited text no. 8    
9.Perstein MA. Evaluation of certain preparations for care of the skin of new born infants. Am J Dis Child 1948; 75: 385-393.  Back to cited text no. 9    
10.Lowenthal UA.The pathogenesis of miliaria. Arch Dermatol 1961;­]sub 84: 52-67.  Back to cited text no. 10    
11.Hurwitz S. Clinical Peadiatric Dermatology. Philadelphia: WS Saunders Co, 1981: 1 - 31.  Back to cited text no. 11    
12.Pratt AG. Perianal dermatitis of new born. Am J Dis Child 1951; 82: 429-433.  Back to cited text no. 12  [PUBMED]  
13.Tanino 3, Steiner M, Benjamin B, et al. The relationship of perianal dermatitis to facial pH. Pediatr 1959; 54: 793-800.  Back to cited text no. 13    
14.Schleicher SM, Scott JM, Lim DO. Congenital neavi. Int 3 Dermatol 1995;34: 825-829.  Back to cited text no. 14    


Tables

[Table - 1], [Table - 2]



 

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