•The site of blister cleavage is the granular layer.
•Mild edema and vascular ectasia are evident in the
dermis, but the absence of inflammatory exudate is striking feature.
CLINICAL FEATURES
•Onset may be preceded by a prodrome of malaise, fever, and irritability, associated with extreme tenderness of the skin.
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•The first sign of the disease - faint, macular, orange red, scarlatiniform eruption .
•The eruption generally becomes more extensive, and over the next 24–48 hr turns to a more confluent, deep erythema with edema.
•The surface then becomes wrinkled before starting to separate, leaving raw, red erosions.
•Sites of erosions are the central part of the face, the axillae and the groins.
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TREATMENT :
•Parenteral antibiotics - cephalosporins or cloxacillin.
•The fluid and electrolyte balance is monitored.
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Perioralerythema and scale-crusts in a neonate |
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OMPHALITIS
•Characterized by redness, oedema and discharge of the ‘stump’.
•Cases can progress to cellulitis and deeper tissue infection.
•More common in protracted labour, non sterile delivery and cord care, prematurity, low birth weight and some cultural practices.
•Treatment :4% Chlorhexidine as dusting powder, tropical antibiotics or systemic antibiotics may be required.
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ECTHYMA GANGRENOSUM
•Caused by -Pseudomonas aeruginosa and occasionally other bacteria like Escherichia coli.
•Clinically starts as painful erythema to ecchymosis.
•The centre of lesion develops a fluid filled lesion or pustule, which then forms an ulcer.
•Ulcers are depressed, necrotic with crusting and elevated edge.
•Eventually multiple lesions develop.
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•Predisposing factors- prematurity, renal failure, neutropenia and immunodeficiencies, necrotizing enterocolitis and bowel surgery.
•Appropriate parenteral therapy is required for treatment.
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VIRAL INFECTIONS
•NEONATAL HERPES SIMPLEX
•FETAL VARICELLA SYNDROME
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NEONATAL HERPES SIMPLEX
•Majority of infections result from transmission of HSV type 1 (20%) and HSV type 2 (80%) through the contact with an infected genital tract during delivery.
•Also by an ascending infection when there is prolonged rupture of membranes or rarely as a transplacental infection.
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•The skin lesions appear between days 2 and 20.
•Isolated or grouped vesicles are the most common type of lesion.
•The scalp ,face and over the presenting part are the most commonly affected sites.
•When intrauterine infection occurs, atrophy or scarring may be present at the site of the lesion.
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•During an intrauterine infection, vesicles appear within 1 day of life.
•If infection is acquired intrapartum, the onset of disease is during first week to 10 days of life.
•Vesicle formation following herpes simplex virus is due to ballooning degeneration of keratinocytes, and the level of cleavage is at the stratum spinosum.
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