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LETTER TO EDITOR
Year : 2020  |  Volume : 21  |  Issue : 3  |  Page : 247-248

Sucking pads – A report of two cases with dermoscopic findings


1 Skin and VD, MDM Hospital, Jodhpur, Rajasthan, India
2 Skin and VD, New Medical College Hospital, Kota, Rajasthan, India

Date of Submission01-Jan-2020
Date of Decision30-Jan-2020
Date of Acceptance17-Mar-2020
Date of Web Publication30-Jun-2020

Correspondence Address:
Dr. Aditi Agrawal
New Medical College Hospital, Kota, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_1_20

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How to cite this article:
Lamoria A, Agrawal A, Mohta A, Pachar S. Sucking pads – A report of two cases with dermoscopic findings. Indian J Paediatr Dermatol 2020;21:247-8

How to cite this URL:
Lamoria A, Agrawal A, Mohta A, Pachar S. Sucking pads – A report of two cases with dermoscopic findings. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 Aug 9];21:247-8. Available from: http://www.ijpd.in/text.asp?2020/21/3/247/288479



Sir,

Sucking pads are tumescent, hyperkeratotic thickenings present on the inner zone of the lips of neonates. They develop around the 25th week of gestation indicating an efficient sucking reflex which is primarily brainstem mediated and is required for successful transformation from intrauterine to extrauterine life. So it is a normal physiological variant requiring no intervention.[1]

We present here two cases of infants who presented with sucking pads. First case was of a 4-months-old infant [Figure 1] who came with complaint of asymptomatic, gradually progressive, flesh colored, grooved wing like swelling over the upper and lower lip since birth along with fullness of cheeks due to continuous suckling efforts and the other infant was 5-month-old [Figure 2] who also presented with similar swelling but was limited to the central part of the upper lip since birth. Both babies were born out of full term normal vaginal delivery and had almost 8–10 breast-feeding sessions/day. Overall, the clinical examination was consistent with a physiological adaptation of lip structures to sucking, which can be mistaken for several pathological conditions by parents. On dermoscopic examination we found white opalescent areas along with normal physiological pigmentary lines [Figure 3].
Figure 1: Sucking pads in 4-month-old infant

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Figure 2: Sucking pads in 5-month-old infant

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Figure 3: Dermoscopic image – Yellow arrow indicates normal physiological lining, black arrow shows white opalescent area indicating intracellular fluid

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The presence of sucking pads at birth is an indication of effective sucking reflex and represents an intact motor neuron function in neonates.[2] The hyperkeratotic thickening of the posterior part of the lips was found, albeit of varying severity in both the infants. This thickening started at the closure line of the lips (both upper and lower) and stretched inward onto the mucosal surface. It varied from whitish to pigmented, and the clinical appearance ranged from smooth to raised, rather square, hyperkeratotic pads.[3] The condition is normal and relatively common anatomical variant. The condition is due to a combination of intracellular edema and hyperkeratosis. Perhaps the alternative term of sucking calluses is more appropriate. The intracellular edema is ascribed to passive diffusion of liquid, presumably saliva, into the cells, while the hyperkeratosis is regarded as an adaptive phenomenon to friction during sucking. Microscopic examination of the histologic specimens reveals increased thickness of the epithelium of the affected area, with broad rete ridges and large, edematous, poorly staining cells in the stratum malpighii. Dermoscopic examination revealed white opalescent areas suggestive of intracellular edema and hyperkeratosis and pigmentary lines which is supposed to be normal physiological finding. The condition appears at birth and resolves by itself in 3–6 months. The lips become dry, cracked and desquamates eventually to leave the lips smooth again and hence requires no treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Heyl T, Raubenheimer EJ. Sucking pads (sucking calluses) of the lips in neonates: A manifestation of transient leukoedema. Pediatr Dermatol 1987;4:123-8.  Back to cited text no. 1
    
2.
Hendrik HD. Sucking-pads and primitive sucking reflex. J Neonatal Perinatal Med 2013;6:281-3.  Back to cited text no. 2
    
3.
Thariat J, Roth V, Marcy PY. Sucking pads in a full-term newborn. J Pediatr 2011;158:66.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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