|Year : 1992 | Volume
| Issue : 2 | Page : 69-72
Cutaneous manifestations in the new born
Bryan Nobby, N Chakrabrty
Five hundred unselected newborn babies delivered at the department of obstetrics and Gynaecology, command hospital, Air force, Bangalore, were examined from ,the first to the fifth day after birth and details of all cutaneous manifestations, both physiological and pathological were recorded. Of the 500 newborns studied, 262 (52.4 percent) were males and 238 (47.6 percent) were females.
Physiological skin changes were observed in all and pathological skin changes in 206 (41.2 percent). The incidence of such changes being similar in both sexes except for the physiological change termed miniature puberty.
The incidence of these manifestations and their comparison with other reports in the literature are presented.
|How to cite this article:|
Nobby B, Chakrabrty N. Cutaneous manifestations in the new born.Indian J Dermatol Venereol Leprol 1992;58:69-72
|How to cite this URL:|
Nobby B, Chakrabrty N. Cutaneous manifestations in the new born. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Feb 22 ];58:69-72
Available from: http://www.ijdvl.com/text.asp?1992/58/2/69/3753
The neonatal period is one of rapid adaptation in which the skin plays an important role and fully assumes for the first .time its function as a barrier and of thermoregulation. A host of aberrations varying from physiological and transient to grossly pathological are seen in the skin of a neonate. The spectrum of dermatological manifestations in neonates varies from era to era and country to country. Some of the most pertinent factors influencing the pattern of cutaneous changes include climate, race, nutrition, hygiene, socioeconomic status, customs, maternal factors, somatic make up sand heredity.
The present study was undertaken to determine the incidence of cutaneous changes, both physiological and pathological, in newborns between the first and fifth days of life.
Materials and Methods
Five hundred unselected newborn babies delivered at the Department of obstetrics and gynaecology, Command Hospital, Air force, Bangalore were studied.
Within 24 hours of birth the neonate was examined in toto including general physical, systemic and dermatological examination and all details were recorded. The neonate was examined daily for the next 4 days and all dermatological findings were noted.
Simple non-invasive investigations such as examination of scrapings for candida, pus swabs for bacterial culture, smears from pustules for Gram-staining and microscopic examination and Tzanck test from vesicles were performed.
Of the 500 newborns studied, 262 (52.4 percent) were males and 238 (47.6 percent) were females. The incidence of both physiological and pathological skin changes were similar in both sexes except for the physiological change termed miniature puberty which was observed in 12 (2.4 percent) female neonates only.
The incidence of physiological skin changes in the early neonatal period as observed in this study are shown in [Table 1]. Pathological skin manifestations were observed in 206 (41.2 percent) neonates, of which 109 were males and 97 were females. These changes have been classified as (1) Transient non-infective diseases, (2) Naevi and other developmental defects, (3) Infections, (4) Dermatitis, (5) Inherited disorders. The Transient non-infective diseases, naevi and other developmental defects observed in this study are listed in [Table 2] (i) & (ii).
Infections were observed in 39 (7.2 percent) newborns of this study group. These include neonatal herpes simplex infections 1 (0.2 percent), neonatal impetigo 6 (1.2 percent), mastitis 2 (0.4 percent), omphalitis 8 (1.6 percent), oral candidiasis 9 (1.8 percent) and cutaneous candidiasis 13 (2.6 percent).
Dermatitis occurred in 64 (12.8 percent) newborns of this study group and consisted of perianal dermatitis 14 (2.8 percent), intertrigo 16 (3.2 percent), cradle cap 22 (4.4 percent) and infantile Seborrhoeic dermatitis 12 (2.4 percent).
Amongst the Inherited disorders only 2 were observed in this study, tuberous sclerosis 1 (0.2 percent) and epidermolysis bullosa simplex 1 (0.2 percent).
The appreciation of normal phenomena and their differentiation from the more significant cutaneous disorders of the neonate is critical. The incidence of physiological skin changes in the newborns in this study group is similar to the findings of other authors. ,, Mongolian spots however occured in 68.8 percent in this study and a similar incidence has been observed in another Indian study,  while western literature reports a low incidence i.e. about 25 percent.  A multiracial study conducted in the USA reported a 95.5 percent incidence in Blacks, 81 percent in Asiatics and 9.6 percent in Whites. 
Erythema toxicum neonatorum (ETN) was the commonest pathological skin change observed in the present study occurring in 153 (30.6 percent). The incidence of ETN and the other transient non-infective disorders as observed in this study correlates well with the findings of other studies,  although a high incidence of 70 percent has been reported in western literature.  Skin infections were observed in 39 (7.8 percent) of this study group, candidiasis 22 (4.4 percent) and omphalitis 8 (1.6 percent) accounting for the majority. Although no data are available on the incidence of the various skin infections in this period of life. The low incidence in this study is in all probability due to the fact that this study was conducted in a modern well-equipped hospital.
Dermatitis was observed in 64 (12.8 percent) in our study and comprised perianal dermatitis in 14 (2.8 percent), intertrigo 16 (3.2 percent), cradle cap 22 (4.4 percent) and infective Seborrhoeic dermatitis 12 (2.4 percent), while incidence of perianal dermatitis has been reported to be as high as 7 percent.  The overall incidence of dermatitis in the neonatal period has been found to be similar in an earlier study. 
Of the naevi and other developmental defects observed, Salmon patch was the commonest occurring in 119 (23.8 percent). The incidence of these developmental defects correlates well with previous reports. ,,,
A rather fortuitous finding in this study was that of a case each of tuberous sclerosis and epidermolysis bullosa simplex. In the former multiple ash leaf shaped hypopigmented macules were present from birth over the trunk and limbs. The patient developed seizures in the seventh month of life. In the later case multiple, flaccid, easily ruptured bullae and erosions distributed predominantly over areas subjected to friction were seen from the second day of life. Histopathological examination of a skin biopsy confirmed the diagnosis of epidermolysis bullosa simplex. While the reported incidence of tuberous sclerosis is 1 per 100,000,  simple form of epidermolysis bullosa is rare. 
|1||Solomon LM, Esterly NB. The Skin. In: Neonatal Perinatal Medicine, (Fanaroff AA, Martin RJ, eds), 2nd edn. St. Louis: CV Mosby, 1983; 939.|
|2||Jogrenson RJ. Intra oral findings and anomalies in neonates. Paediat 1982; 69: 577.|
|3||Hurwitz S. Clinical Paediatric Dermatology, 2nd edn. Philadelphia: WB Saunders company, 1981; 6.|
|4||Siddappa K, Inamdar A C. Clinical study of transient cutaneous lesions in Newborn babies on the first day, paper read at XVII Conference of IADV & L, Bombay, 1989.|
|5||Osburn K. Congenital pigmented and vascular lesions in newborn infants. J Amer Acad Dermatol 1987; 16: 788-92.|
|6||Jacobs AH, Walton RG. Incidence of birth marks in neonates. Paediat 1976; 58:218-22.|
|7||Schachner L, Press S. Vesicular bullous and pustular disorders of infancy and childhood. Paediat Clin N Amer 1983;30(4):609-29.|
|8||Hodgman JE, Freedman RI, Levan NE. Neonatal Dermatology. Paediat Clin N Amer 1971; 18(3): 713-56.|
|9||Pratt AG, Read WT. Perianal dermatitis in neonates. J Paediat 1955; 46:593.|
|10||Yates VM. Dermatitis in Neonates. Brit J Dermatol 1983; 108: 633-8.|
|11||Alpers JC. Congenital Naevi. Arch Dermatol 1985; 121: 734-5.|
|12||William L. Paediatric (Neonatal) Dermatology. In: Dermatology in General Medicine (Fitzpatrick TB, Eisen AZ, Wolff K,et al, eds), 3rd edn. New York: MC Graw-Hill Book company, 1987; 2631.|
|13||Watson W. Selected Genodermatoses. Paediat Clin N Amer 1978; 25 (2) : 263-9.|
|14||Pearson RW. Clinico pathological types of epidermolysis bullosa and their nondermatological complications. Arch Dermatol 1988; 124: 718.|