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ORIGINAL ARTICLE
Year : 2019  |  Volume : 20  |  Issue : 1  |  Page : 36-40

A study of neonatal dermatoses in a tertiary care center


1 Department of Dermatology, Venereology and Leprosy, Koppal Institute of Medical Sciences, Koppal, Karnataka, India
2 Department of Pediatrics, Koppal Institute of Medical Sciences, Koppal, Karnataka, India

Date of Web Publication14-Dec-2018

Correspondence Address:
Dr. K Udaya
Department of Pediatrics, Koppal Institute of Medical Sciences, Hospet Road, Koppal - 583 231, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_49_18

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  Abstract 


Background: Neonatal dermatoses by definition encompass the spectrum of cutaneous disorders that arise during the 1st 4 weeks of life. The appreciation of normal phenomena and their differentiation from the more significant cutaneous disorders of the newborn is critical for the dermatologists and pediatricians. Aims and Objectives: The aim of the study is to estimate the prevalence of various neonatal dermatoses and identify varying patterns of various physiological and pathological dermatoses. Materials and Methods: This was a hospital-based, cross-sectional study conducted during a period of 6 months. A total of 150 neonates were examined and data were collected, and results were analyzed statistically. Results: Out of 150 neonates, 147 (98%) had cutaneous lesions. Among them, 79 (52.6%) were male and rest were female. Of these, 112 (74.6%) weighed between 2.5 and 4 kg, 35 (23.3%) <2.5 kg, and 3 (2%) >4 kg. Physiological skin lesions were most common features seen in 148 (98.6%), followed by birthmarks 46 (31.3%), transient noninfectious lesions 35 (23.3%), inflammatory eruptions 13 (8.6%), and infections 7 (4.6%). Conclusions: A good knowledge of neonatal dermatoses is necessary for the treating dermatologists and pediatricians as many of cutaneous conditions are transient, appearing in the 1st few days to weeks of life, only to disappear shortly thereafter. However, their occurrence makes the parents worrisome. Proper diagnosis of the conditions helps in relieving the anxiety of parents and caregivers.

Keywords: Genodermatoses, neonates, transient


How to cite this article:
Pandit VS, Udaya K. A study of neonatal dermatoses in a tertiary care center. Indian J Paediatr Dermatol 2019;20:36-40

How to cite this URL:
Pandit VS, Udaya K. A study of neonatal dermatoses in a tertiary care center. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 May 19];20:36-40. Available from: http://www.ijpd.in/text.asp?2019/20/1/36/247555




  Introduction Top


The neonatal period is defined as <28 days of life. The skin of the neonate differs from that of an adult in that it is thinner and less hairy.[1] It serves an important role in the transition from the aqueous intrauterine environment to extrauterine life. The skin of the newborn rapidly adapts to the changing environment and may exhibit a variety of lesions which may be transient, physiological, or pathological. Early recognition/differentiation of these conditions is necessary to properly diagnose the benign physiological conditions and other pathological disorders such as infections or genodermatoses, which need proper intervention and treatment. This study was conducted to estimate the prevalence of various neonatal dermatoses and identify varying patterns of various physiological and pathological dermatoses.


  Materials and Methods Top


This was a hospital-based, cross-sectional study conducted during a period of 6 months between September 2017 and February 2018. A total of 150 neonates were examined who attended the dermatology outpatient department, admitted in the postnatal ward of obstetrics and gynecology and special newborn care unit. A detailed history regarding maternal age, parity, consanguinity, mode of delivery, and maternal illness during pregnancy was elicited and recorded in a preformed pro forma. All neonates were examined thoroughly, and parameters such as age, sex, birthweight at the time of examination, and presence of systemic illness were recorded. The morphology and site of each skin lesion, were noted and diagnosis was made on the basis of clinical features only. Ethical committee clearance was obtained from the institutional ethical committee, and written consent forms were obtained from parents of neonates to use patients' data. The relationship between skin lesions and various maternal and neonatal aspects is calculated using Microsoft Excel 2010 and Chi-squared test. P < 0.05 was considered statistically significant.


  Results Top


In this study of 150 neonates, 147 (98%) had cutaneous lesions. Among them, 79 (52.6%) were male and rest were female making M:F ratio of 1.1:1. Majority of the neonates were born at term 119 (79.3%), followed by preterm 25 (16.6%) and postterm babies 6 (4%). Of these, 112 (74.6%) weighed between 2.5 and 4 kg, 35 (23.3%) <2.5 kg, and 3 (2%) >4 kg. History of consanguinity was present in 58 (38.7%) cases. Most of the mothers of neonates were of age <35 years and only 2 (1.3%) were above 35 years. Most of the mothers were multiparous 94 (62.7%) as compared to primiparous women 56 (37.3%). Among these, 121 (80.7%) had received the prenatal health care and 21 (14%) of the mothers had gestational risk factors. [Table 1] shows the neonatal characteristics and the gestational risk factors. Majority of neonates were delivered by (58.6%) normal vaginal mode and (41.3%) by cesarean section.
Table 1: Characteristics of neonates and gestational risk factors of mothers

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In this study, among all the cutaneous features in neonates, physiological skin lesions were most common features seen in 148 (98.6%), followed by birthmarks 46 (31.3%), transient noninfectious lesions 35 (23.3%), inflammatory eruptions 13 (8.6%), and infections 7 (4.6%). Majority of the neonates had more than one cutaneous feature. The list of various neonatal dermatoses is shown in [Table 2].
Table 2: Prevalence of skin lesions in neonates

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Most of the skin lesions are commonly seen in term newborns as compared to pre- and postterm babies. The most common dermatological finding was Mongolian spots (MS) (41, 27.3%), followed by neonatal erythema (31, 20.7%), lanugo (28, 18.7%), and physiological desquamation (27, 18%). MSs were more prevalent in the babies who were born to consanguine parents (P = 0.053) and who had gestational risk factors (P = 0.019).

Among the physiological skin lesions, neonatal erythema 31 (18.7%) was the most common feature and vaginal bleeding 1 (0.7%) was least manifested feature. In transient skin conditions, common features seen among newborns were miliaria [Figure 1] followed by erythema toxicum neonatorum (ETN) and neonatal acne.
Figure 1: Clinical photograph of miliaria

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Regarding the Apgar score in the 1st min of life, a higher prevalence of milia was observed in neonates with Apgar score <7 and it was statistically significant (P = 0.029). Miliaria, lanugo, MS, ETN [Figure 2], and neonatal erythema had a higher prevalence in babies with Apgar score <7 in the 1st min of life but without statistical significance.
Figure 2: Clinical photograph of erythema toxicum neonatorum

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The type of delivery also influenced the presence of some dermatological findings. ETN was more common in neonates who were born out of vaginal delivery and it was statistically significant (P = 0.02). A higher prevalence of ETN in vaginal births was also observed in other study.[2] Neonates born by vaginal delivery also had a higher prevalence of miliaria, vernix caseosa, and sebaceous hyperplasia, but the association was not statistically significant. Those born by cesarean section had more physiological desquamation, genital hypertrophy, and hyperpigmentation without statistical significance.

Pregnancy-induced hypertension, age of mother, sepsis, and hypothyroidism did not have any significant association with the occurrence of the cutaneous lesions in neonates.


  Discussion Top


The prevalence of dermatological findings in newborns was studied by many authors in different parts of the world and it has varied between 40% and 99.3%.[2],[3] In our study, among 150 newborns, 98% had cutaneous manifestations.

MS were the most common skin lesion among newborns with a percentage of 27.3%. The frequency of MS varies from 7% to 75% as seen in various ethnic groups.[4],[5] Majority of MS were found on the lumbosacral regions. In this study, a few of the newborns had MS on the upper and lower extremities. MS were significantly higher in males than females and were more prevalent in term babies, P = 0.007 and 0.004, respectively. The maternal factor that affected the occurrence of MS was diabetes mellitus during pregnancy. This correlation was not found in the study done by Boccardi et al.[6] and in our study.

The 2nd most common finding was neonatal erythema (20.7%) comparable with a study by Reginattoa et al.[7] These were more common among male and term babies; prevalence was high in consanguine parents and multiparous women.

Physiological scaling is a benign superficial skin desquamation affecting 18% of the newborns which was within the literature range (7.2%–83%).[3],[8],[9] It was also common among male and term babies, multiparous mothers, and consanguine parents. The prevalence of physiological desquamation was more in those whose mother had received antenatal care and delivered by cesarean section.

Miliaria was the most common transient skin lesion presented in 22 (14.7%) neonates which was comparable with the other studies.[3],[10],[11] A higher incidence was seen in term babies and in babies weighing >2.5 kg, delivered vaginally, and with Apgar score <7 in the 1st min of life.

Genital hyperpigmentation was seen in 18 (12%) neonates, genital hypertrophy in 10 (6.7%), and vaginal bleeding in 1 (0.7%) as common findings of miniature puberty. In this study, no associations were found between prematurity and genital hyperpigmentation, genital hypertrophy, or cutis marmorata (physiologic, transitory reticulated bluish mottling of the skin) which was similar to a study by Reginattoa et al.[7]

The prevalence of vernix caseosa (grayish-white creamy fetal skin biofilm) and milia (pearly white or yellow small retention cysts) was 58.8% and 6.7%, respectively, in our study. The prevalence of milia [Figure 3] was low as compared to the other studies[9],[12] but comparable with the study by Jawade et al.[11] An increased prevalence of vernix caseosa and milia was seen in term neonates and whose mothers had a regular antenatal checkup with dietary supplementation of iron and folic acid. Milium is one of the indicators of skin maturity.
Figure 3: Clinical photograph of milia

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Sebaceous hyperplasia (tiny yellowish facial papules) was seen in 8.7%; more prevalent in term babies (one more indicator of skin maturity) and babies born out of vaginal deliveries.

ETN is a transient noninfective benign vesicular eruption, seen in 6% of neonates in this study. Its prevalence varied in other studies from 7% to 38%.[8],[10],[11] Unlike the study[7] which showed no association with mode of delivery, the prevalence of ETN in our study was more in vaginal births and it was statistically significant; this was similar to a study by Ekiz et al.[2]

Benign cephalic pustulosis is a facial acneiform eruption, which was seen in 2 (1.3%). Suckling pad and axillary pigmentation were noted in 9 (6%) and 5 (3.3%), respectively, in this study. The prevalence of later two was a bit higher than the study by Gudurpenu et al.[13] The prevalence of seborrheic dermatitis was 13 (8.6%) in this study which was similar to a study by Jawade et al.,[11] but higher than a study by Gudurpenu et al.[13]

Among genodermatosis, features of ichthyosis (collodion-like membrane) and epidermolysis bullosa simplex were seen in 2% and 0.7% of neonates, respectively. Neonates with collodion-like membrane [Figure 4] were males and born out of consanguineous marriage. One interesting case was found in this study, which was not mentioned in any earlier reported studies. One male baby was born with oculocutaneous albinism with symptoms of photophobia and diluted pigmentation of skin and hair. This baby was born out of consanguineous marriage. His parents were normal. Albinism is a genetic disorder inherited in an autosomal recessive pattern except for rare instances of dominant inheritance. It is characterized by the absence of pigmentation of skin, hair, and eyes at birth.[14]
Figure 4: Clinical photograph of neonate with collodion-like membrane

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The prevalence of infectious lesions in the present study was comparable with that reported for newborns in neonatal Intensive Care Units (4%) and other studies.[8],[11],[15] The low prevalence is probably because mainly admitted neonates were examined in this study. The evidence of injury during delivery was in the form of caput succedaneum (3, 2%) and subgaleal hematoma (1, 0.7%), which occurred during vaginal delivery.

Nevus sebaceous [Figure 5] 1 (0.7%), nevus depigmentosus 1 (0.7%), and congenital melanocytic nevus with the prevalence of 1 (0.7%) were similar when compared to other studies.[4],[8],[11],[16] Cutis marmorata [Figure 6] 2 (1.3%), salmon patch 3 (2%), and occipital alopecia 2 (1.3%)were the other less common features found in neonates of this study. A single neonate with cleft lip was seen in this study. No other associated abnormalities were seen in this male baby. The number of participants taken during 6-month period was less, which was the limitation of this study.
Figure 5: Clinical photograph of nevus sebaceous

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Figure 6: Clinical photograph of cutis marmorata

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  Conclusions Top


All dermatologists and pediatricians should be aware of neonatal dermatoses and their patterns of presentation, course, and prognosis. Our study sheds the light on knowledge about various physiological as well as pathological conditions affecting the neonates. Almost all neonates had cutaneous findings, and physiological skin manifestations were the most common of all, which are similar to findings of other studies. Various maternal and fetal factors influence the occurrence of the neonatal dermatosis as an association was observed between specific skin lesions and these factors such as gestational age, parity, history of consanguinity, type of delivery, gender, and Apgar score at the 1st and 5th min of birth. MS, neonatal erythema, lanugo, and physiological scaling are the common cutaneous features seen in this study. Correct diagnosis of these physiological and pathological conditions in newborns and counseling of the parents relieve the anxiety, avoiding unnecessary diagnostic testing and treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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