Condition | Clinical features | Significance |
Infectious conditions | ||
Congenital herpes simplex virus (HSV) | Grouped or single vesicles on erythematous base in crops on skin and mucous membranes; lesions usually appear between 1 and 2 weeks of age; may be associated with nonspecific signs of serious illness: temperature instability, respiratory distress, poor feeding, lethargy | Requires antiviral therapy; significant morbidity and mortality if untreated |
Neonatal varicella zoster virus | Grouped or single vesicles on erythematous base in crops on skin and mucous membranes | Requires antiviral therapy; associated with significant morbidity and mortality |
Congenital syphilis | Blisters, erosions that frequently involve the palms and soles; other manifestations include rhinitis, anemia, jaundice, hepatomegaly | Requires antibiotic therapy; late manifestations in untreated infants may include central nervous system, skeletal, and dental abnormalities; hearing loss; and interstitial keratitis |
Staphylococcal pustulosis | Erythematous papules, pustules, honey-colored crusts often in areas of trauma | Requires antibiotic therapy; Gram stain and culture of lesions should be obtained; may be associated with systemic/invasive infection |
Staphylococcal scalded skin syndrome (SSSS) | Fever, irritability, diffuse blanching erythema, flaccid blisters; positive Nikolsky sign* | Requires antibiotic therapy; cultures should be obtained from any suspected focus of infection (eg, blood, urine, nasopharynx, umbilicus) |
Streptococcal infections | May mimic staphylococcal infections | Same as for staphylococcal pustulosis and SSSS |
Listeria | Pustules of the skin and mucus membranes may be present in early onset disease (<7 days of age) | Requires antibiotic therapy; may be associated with septicemia and/or meningitis |
Candidiasis | Erythematous macules and papules evolving to pustules and vesicles | Requires antifungal therapy; has the potential to disseminate via the bloodstream in susceptible hosts |
Congenital disorders | ||
Epidermolysis bullosa | Blister development with little or no trauma | Management involves prevention of trauma, careful wound care, and treatment of infection |
Epidermolytic hyperkeratosis | Widespread blistering and erythema and or hyperkeratosis; denuded areas of skin | Increased susceptibility to cutaneous infection |
Aplasia cutis congenita | Erosions present at birth that re-epithelialize to form hypertrophic or atrophic scar; involves the epidermis and dermis | May be associated with other disorders (eg, trisomy 13, 4p-) |
Incontinentia pigmenti | Four stages that may occur simultaneously: linear streaks of erythematous papules and vesicles; warty papules or plaques in linear or swirling patterns; swirled; hypopigmented patches or streaks | Majority of cases associated with neurologic, ocular, dental, and structural abnormalities |
Miscellaneous | ||
Scabies | May be seen in infants as young as 3 to 4 weeks of age but never present at birth; vesicles, pustules, and papules; rare burrows on hands, feet, trunk, genitalia | Requires treatment with scabicide and measures to prevent spread |
Cutaneous mastocytosis | Bullous eruptions with hemorrhage; positive Darier sign¶ | Requires symptomatic therapy and avoidance of triggers |
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