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ORIGINAL ARTICLE
Year : 2017  |  Volume : 18  |  Issue : 1  |  Page : 18-23

A clinical study of cutaneous lesions in neonates at a tertiary health care center in Chennai


Department of Dermatology, Sri Ramachandra University, Chennai, Tamil Nadu, India

Date of Web Publication12-Dec-2016

Correspondence Address:
Aditya Kumar Bubna
Department of Dermatology, Sri Ramachandra University, Chennai - 600 116, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.188423

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  Abstract 


Background: Neonatal dermatoses constitute an important category of cutaneous disorders. They range from physiological transient conditions at one end to serious pathological entities at the other. Any of these could be a source of immense anxiety to the parents, and therefore the significance of their adequate awareness amongst dermatologists.
Aim and Objective: To study the clinical pattern of various dermatoses in neonates at a tertiary health care center in Chennai.
Materials and Methods: This was a descriptive, cross-sectional, and observational study conducted at our institute which included a detailed dermatologic examination of each neonate followed by recording each finding and their statistical analysis.
Results: In the 220 neonates analyzed, 97 were females (44.1%) and 123 males (55.9%), with 126 being term babies (57.3%), 86 preterm (39.1%), and 8 postterm (3.6%). Physiological skin changes (52.7%) were the most common cutaneous change identified, followed by transient non-infective dermatoses (20%), developmental defects (7.3%), birth marks (7.3%), eczema (6.8%) and infections (5.9%).
Conclusion: Studying neonatal dermatoses holds significance to all dermatologists so that they are able to differentiate physiological and pathological conditions, thereby relieving unnecessary therapy for neonates in circumstances not requiring any and also facilitating to allay undue anxiety among parents.

Keywords: Aplasia cutis congenita, Mongolian spot, neonatal dermatoses


How to cite this article:
Gudurpenu S, Bubna AK, Rangarajan S, Veeraraghavan M, Krishnamoorthy M, Rajesh G. A clinical study of cutaneous lesions in neonates at a tertiary health care center in Chennai. Indian J Paediatr Dermatol 2017;18:18-23

How to cite this URL:
Gudurpenu S, Bubna AK, Rangarajan S, Veeraraghavan M, Krishnamoorthy M, Rajesh G. A clinical study of cutaneous lesions in neonates at a tertiary health care center in Chennai. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Dec 8];18:18-23. Available from: http://www.ijpd.in/text.asp?2017/18/1/18/188423




  Introduction Top


Neonatal period refers to the first 4 weeks of extra-uterine life.[1] The skin and appendages of the new-born present different features when compared to adults. There are many physiologic and pathologic conditions specific to neonatal skin. Therefore, an imperative knowledge of neonatal skin biology is essential for all dermatologists, the reason being that many dermatoses though appearing formidable could actually be transitory or physiologic undergoing rapid involution.[2],[3] This would thus be helpful in allaying undue anxiety for the parents and avoiding unnecessary expenditure on treatments not otherwise required. However, there are a few disorders that could also be serious needing appropriate therapy along with genetic counselling and psychologic support, the management of which is generally multi-disciplinary which the treating dermatologist should be aware about so that timely intervention could facilitate a better therapeutic outcome.[4]

Aims and Objectives

The main aim and objective of this study was to identify neonatal dermatoses and estimate the prevalence of physiologic and pathologic lesions in neonates after studying their various patterns.


  Materials and Methods Top


This was an observational, cross-sectional, and descriptive study done at our institute from December 2012 to September 2013 after getting the approval from the Institutional Ethics Committee. A total of 220 cases were studied in the given period after recruiting them from the dermatology outpatient department, postnatal ward of the Obstetrics and Gynaecology Department and the Neonatal Intensive Care Unit. A detailed history pertaining to the mother's age, history of consanguinity, mode of delivery, and any maternal illness during pregnancy was elicited. Following this, all the participants were thoroughly examined in broad day light to accurately define the morphology of skin lesions, which was documented accordingly. Other parameters that were recorded included sex, birth weight, and age at the time of examination. In all instances, the diagnosis was derived solely based upon the clinical impression. As all variables in our study were qualitative, they were expressed as percentage values.


  Results Top


Of the 220 participants evaluated, 123 (55.9%) were males and 97 (44.1%) were females. Of all the babies examined, 126 (57.3%) were term babies, 86 (39.1%) were preterm, and 8 (3.6%) were postterm. The frequency of skin lesions seen in our participants has been depicted lucidly in [Table 1].
Table 1: Frequency of skin lesions in neonate in our study

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Of all the cutaneous lesions in the newborn, physiological skin lesions were most common, seen in 116 (52.7%) neonates. This was followed by transient non-infectious conditions in 44 (20%) neonates, birth marks in 16 (7.3%), developmental defects in 16 (7.3%), eczematous eruptions in 15 (6.8%) and infections in 13 (5.9%) neonates.

Out of the physiological skin lesions, the occurrence of Mongolian spots (MSs) ranked maximum at 10.5%, followed by sebaceous gland hyperplasia and milia, both demonstrating a prevalence of 6.8% in our study.

Based on neonatal maturity, the occurrence of physiologic skin changes has been summarized in [Table 2].
Table 2: Distribution of physiological skin lesions with respect to maturity in the participants of our study

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On scrutinizing these findings, we deciphered that in postterm babies apart from an isolated finding of a MS, none of the other entities were identified. Full term babies and preterm babies on the other hand depicted these changes amounting to a total prevalence of 26.4% and 23.2%, respectively.

In full term neonates, the most common physiologic skin changes witnessed were vernix caseosa [Figure 1], MS and hypertrichosis, each amounting to 4.1%, followed by sebaceous gland hyperplasia (3.6%) and milia (3.2%).
Figure 1: Vernix caseosa

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In preterm babies, on the other hand, the most common finding observed was MS (5.9%), followed by physiological scaling in the newborn (4.1%), milia (3.6%), and sebaceous gland hyperplasia (3.2%).

The occurrence of vascular abnormalities in our study population was seen in only 10 (4.5%) neonates, out of which cutis marmorata was the most common entity encountered in 6 (2.7%) of the neonates, followed by harlequin color change in 3 (1.4%) and acrocyanosis in 1 (0.5%).

Of the pigmentary abnormalities detected in 26 (11.9%) neonates, MS was seen in 23 (10.5%) neonates followed by genital pigmentation in 2 (0.9%) and axillary pigmentation in 1 (0.5%).

With reference to the transient noninfective conditions, erythema toxicum neonatorum (ETN) was seen in 20 (9%) newborns followed by transient neonatal pustular melanosis (TNPM) in 15 (6.8%), miliaria rubra in 5 (2.3%), miliaria crystallina in 2 (0.9%), and infantile acropustulosis [Figure 2] in 2 (0.9%).
Figure 2: Infantile acropustulosis

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Only 3 patterns of eczemas were seen among our study population. Out of the 15 (6.8%) neonates detected with eczematous skin lesions, infantile seborrhoeic dermatitis (SD) was seen in 10 (4.5%), followed by napkin dermatitis (ND) in 3 (1.4%) and perianal dermatitis (PD) in 2 (0.9%).

There were two infections alone, that were detected in the neonates of our study, namely candidiasis in 10 (4.5%) and bullous impetigo in 3 (1.4%).

Nevi was seen in 16 (7.3%) neonates. Out of these, salmon patch (SP) constituted 4.1%, nevus sebaceous of Jadassohn (NSJ) [Figure 3] 0.9%, congenital melanocytic nevi (CMN) [Figure 4] 1.8% and port wine stain (PWS) 0.5%.
Figure 3: Nevus sebaceous of Jadassohn

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Figure 4: Congenital melanocytic nevus

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Of the 220 cases, 16 (7.27%) had developmental anomalies. 2 (0.9%) patients had cleft lip and cleft palate [Figure 5] together, 1 (0.5%) had umbilical hernia [Figure 6], and 13 (5.9%) presented with aplasia cutis congenita (ACC) [Figure 7].
Figure 5: Cleft lip

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Figure 6: Umbilical hernia with a raspberry tumour

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Figure 7: Aplasia cutis congenita

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  Discussion Top


Most neonatal dermatoses are usually physiologic or transient occurring conditions, developing during the first 4 weeks of life. There have been many studies analyzing neonatal dermatoses. Our study differed from the previous studies in comprehensively studying many other dermatoses that were not mentioned in all other previous studies.

MS was the most common entity identified in our study. MS is a type of ceruloderma presenting as an ill-defined area of grey to blue black pigmentation. Though a physiologic condition per se, it may have an association with inborn errors of metabolism.[5] MS gradually begins to fade after 1 year and by 6 years, it is rarely identifiable.[6] The frequency of MS varies from 7% to 75% as seen in various ethnic groups. In our study also, the incidence of 10.5% fitted within the previous described range. However, the proportion was much less compared to other studies [7],[8],[9],[10],[11],[12],[13],[14],[15] done on neonates and has been depicted in [Table 3].
Table 3: A comparative representation of the occurrence of neonatal dermatoses of similar previous studies with ours

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The second most common condition in our study was sebaceous gland hyperplasia depicting an incidence of 6.8%. Sebaceous gland hyperplasia in the newborn is a physiologic event secondary to the influence of maternal androgens. This presents as multiple pin point uniform yellowish papules over the cheeks, nose, forehead, and upper lips. In other studies, the occurrence of sebaceous gland hyperplasia varied from 21.4% to 62%.[8],[9],[10],[13],[14] In our study though, the incidence was considerably less [Table 3].

Milia refers to follicular epidermal cysts appearing as numerous facial 1–3 mm globular papules. Its occurrence in our participants was similar to sebaceous gland hyperplasia. These findings again were considerably lower in comparison to previous reports on its incidence,[7],[8],[9],[10],[12],[13],[14],[15] except for the study done by Jawade et al.,[11] where the incidence was 9.92% [Table 3].

Physiologic desquamation of the newborn is a superficial cutaneous desquamation. Previous records have reported its occurrence to range from 7.2% to 83%.[7],[8],[9],[10],[12],[13],[14],[15] Our study recorded a value of 5.9% which was much lower when compared to other studies for the same [Table 3].

Our findings for miniature puberty were almost similar to the findings of Nobby and Chakraborty [13] However, the incidence recorded by Jain et al.,[10] was considerably higher when compared to all previous studies for the same [9],[14] [Table 3].

Epstein pearls (EPs) are yellowish white keratinous cysts ranging in size from 1 to 2 mm. It is seen in the oral cavity generally involving the alveolar ridge and the junction of the hard and soft palate. The incidence of EPs has ranged from 17.5% to 86% in previous studies.[7],[8],[9],[10],[12],[13],[14] In our study, the occurrence was only 1.8%, a value significantly less when compared to previous values.

ETN is a common benign vesicular neonatal eruption seen in 50% of full term neonates. Our study recorded an incidence of 9% for ETN, only comparable to the findings of Gokdemir et al.[9] and Jawade et al.[11] In other studies, though the incidence ranged from 21% to 38%.[7],[8],[10],[12],[13],[14],[15]

TNPM is a clinical condition characterized by prominent nonerythematous pustules that rupture leaving behind a collarette of scales and hyperpigmentation that may persist for several months. It generally affects 5% of neonates characterized by a dark complexion. In our study, it was seen in 6.8% of the population exceeding the values of all previous studies in this regard [11],[12],[13] [Table 3].

Miliaria is a common disorder seen in 15% of newborns, occurring as a result of sweat duct occlusion. Miliaria in our study depicted very low values when compared to results evaluated by other authors [7],[8],[10],[11],[13],[14] [Table 3].

Neonatal acropustulosis is an uncommon disorder with its etiology still not fully elucidated and characterized by recurrent crops of pruritic vesiculopustules around 1–4 mm in size involving the palms and soles. None of the previous studies made mention of this entity. However, in our study, we estimated an incidence of 0.9%, thereby demonstrating the rarity for this clinical entity [Table 3].

ND is an inflammatory dermatoses of the napkin area. Our study had a comparative lower incidence of ND (1.4%) with respect to other studies in this regard by Jain et al.,[10] Sadana et al.,[15] and Jawade et al.[11] [Table 3].

PD has been reported to have a higher incidence in babies fed with cow milk when compared to breast fed neonates. The incidence of PD in our study was almost similar to the report of Jawade et al.,[11] but definitely lower than that depicted by Dash et al.[8] [Table 3].

For SD, an incidence of 4.5% was seen in our study, slightly lower than the finding of Jawade et al.,[11] and certainly much less than the conclusion derived by Jain et al.[10]

Out of the infections, only two were identified in our participants, namely impetigo and candidiasis. The occurrence of impetigo was intermediate to the earlier studies done by Baruah et al.[7] and Jawade et al.[11]

Cutaneous candidiasis however had a higher incidence in our study with values equal to that of Jawade et al.,[11] and much higher when compared to findings by Dash et al.,[8] Sadana et al.,[15] Jain et al.,[10] and Baruah et al.[7]

The incidence of SP in various studies has ranged from 0.72% to 35%. Our finding of 4.1% fitted with the values described before.[7],[10],[11],[12],[13],[14]

PWS in our study with an incidence of 0.5% was at par with most of other studies in this regard.[8],[11],[13],[15]

Similarly, the incidence pattern of CMN in our study did not differ with the incidence pattern described in preceding studies.[7],[8],[11],[13],[14],[15]

ACC on the other hand demonstrated an incidence of 5.9%, by us. The occurrence of this entity has not been enumerated by other authors in their studies, thereby we presume whether any specific link with respect to geographic location could have played a contributory role here.

NSJ was another finding seen in our patients not witnessed in other previous studies.


  Conclusion Top


All dermatologists should be aware of neonatal dermatoses and their patterns of presentation. With regard to the increased incidence of developmental defects in our study, the authors feel there could be a link with respect to genetic and environmental factors, with urbanization and industrialization also contributing for the same.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
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2.
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Jawade SA, Chugh VS, Gohil SK, Mistry AS, Umrigar DD. A clinico-etiological study of dermatoses in pediatric age group in tertiary health care center in South Gujarat region. Indian J Dermatol 2015;60:635.  Back to cited text no. 11
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Nobby B, Chakraborty N. Cutaneous manifestations in the new born. Indian J Dermatol Venereol Leprol 1992;58:69-72.  Back to cited text no. 13
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Sadana DJ, Sharma YK, Chaudhari ND, Dash K, Rizvi A, Jethani S. A clinical and statistical survey of cutaneous changes in the first 120 hours of life. Indian J Dermatol 2014;59:552-7.  Back to cited text no. 15
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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