Australian Doctor 1st September 2023 AD 1st Sept Issue | Page 20

the visualisations of mites , eggs ,

block , hepatobiliary disease , and

eggshell fragments or mite pellets . 21 The typical dermatoscopic pattern of

FBC abnormalities . Suspected NLE requires urgent

scabies is described as a “ delta-wing

referral to a paediatric hospital and

jet ” with a contrail-type appearance ,

a complete physical examination ,

representing the dark brown triangu-

FBC , LFTs and ECG . Diagnosis is con-

lar head preceded by a whitish struc-

firmed based on clinical features of

tureless ( curved or wavy ) burrow ( see

NLE and when NLE-associated anti-

figure 4 ). Most scabies infestations

bodies are present in the serum of

only involve a low number of mites ,

the mother and affected child . The

so an inability to visualise mites from

cutaneous manifestations are tran-

skin scrapings microscopically does

sient and self-limiting and may be

not rule out the diagnosis . 22

managed with topical corticoster-

The treatment of choice in infants

oids and sun protection . The progno-

aged older than two months is per-

sis of NLE is varied in neonates with

methrin 5 % cream applied to the

congenital heart block depending on

whole body and washed off after eight hours . 19 A critical aspect of scabies management is the treatment of all

the degree of block . Two-thirds of newborns with associated congenital heart block require pacemakers . 34

household family members and close contacts to reduce chances of reinfection . Scabies eradication protocols

Ichthyoses

Ichthyoses are disorders of cornifica-

such as hot washing of bedding and

tion that are characterised by exces-

clothing may be required in severe cases . 23 This entire process is repeated on day seven . In neonates aged under two months , crotamiton cream is the treatment of choice , with application to the whole body and washing off

Figure 1 . Atopic dermatitis with facial involvement .

sive dryness , scaling and thickening of the skin ( see figure 8 ). 35 These conditions may be present at birth and range in severity . Ichthyotic conditions that manifest in the neonatal period may present initially as a col-

after 24 hours , repeated daily for three days . 19 Post-scabietic itch may last for weeks after elimination of the mites .

A

B

lodion baby ( with tight and shiny film encasing the neonate ) or scaling erythroderma , and in rarer cases ,

Cradle cap

Infantile seborrhoeic dermatitis or

as harlequin ichthyosis / a harlequin fetus ( a severe genetic disorder where infants are born prematurely with

‘ cradle cap ’ is characterised by a greasy

very thick , hard skin over most of the

yellow scale on the scalp ( see figure

body that forms large , rectangular

5 ). The aetiology and pathogenesis is unknown , however it is theorised

plates separated by deep fissures ). 36 In severe ichthyoses such as harle-

that it may arise from vernix caseosa

quin ichthyosis or Netherton syn-

and sebaceous secretions with contributions from malassezia . 24 Infantile seborrhoeic dermatitis is usually

drome ( which affects the skin , hair and immune system ), neonates are at risk of life-threatening complications

asymptomatic and resolves without

such as hypernatraemic dehydration ,

intervention over weeks to months . 25 If required , treatment of seborrhoeic

infection , sepsis and hyperpyrexia . 35 General principles of manage-

dermatitis involves the application

ment for ichthyoses in infants

of a gentle baby shampoo containing

include frequent bathing and emol-

selenium , zinc or ketoconazole .

Tinea

Cutaneous infection with dermatophyte fungi may affect any part of the body . Infections are named according

Figure 2 . Psoriasis .

A . Plaque psoriasis .

B . Guttate psoriasis .

lients to prevent water loss and soften the stratum corneum . 37 Patients with severe forms of ichthyoses require early dermatology input , with consideration of systemic retinoids in severe cases .

to anatomical location : tinea corporis ( body ), capitis ( scalp ), pedis ( feet ), unguium ( nails ), faciei ( face ), cruris ( groin ). 26 In infants , tinea most commonly affects the exposed face and

PUSTULAR RASHES

Toxic erythema of the newborn

TOXIC erythema of the newborn is a

scalp . The clinical presentation of tinea capitis is an erythematous , scaly lesion

benign , self-limiting condition that affects up to 70 % of newborns . 38 Most

with partial alopecia . A ‘ kerion ’ is a

cases begin a few days after birth and

severe form of tinea capitis that is char-

are characterised by erythematous

acterised by a crusting , pustular and

papules , macules and pustules . Indi-

tender plaque , which if left untreated

vidual lesions typically resolve within

may result in permanent scarring alopecia . 27 Dermatophytosis presents as annular plaques with tiny pustules or

a day and neonates are otherwise well . Although the aetiology of the condition is not entirely understood ,

superficial scaling ( see figure 6 ). Infec-

it is suggested that it is a hypersensi-

tions can be acquired through direct

tivity reaction to mechanical or ther-

skin contact with an infected animal ,

mal stimuli . The diagnosis of toxic

individual , fomites or from second-

erythema of the newborn is typically

ary spread from dermatophytosis of

made on clinical grounds with no

another region .

investigations required . Toxic ery-

Skin scrapings prepared with potas-

thema of the newborn resolves within

sium hydroxide can confirm diagnosis

weeks without any treatment . 38

with direct visualisation of segmented hyphae under the microscope . 28 Also request fungal culture , which may take

Figure 3 . Scabies .

Miliaria

Miliaria , also known as ‘ heat rash ,’

up to four weeks . Collect samples from the active border of the lesion for highest yield . Topical antifungals are typi-

infection , such as a kerion , to a paediatrician or dermatologist to prevent irreversible alopecia .

true allergy to medication . Mild topical corticosteroids are sufficient to manage an id reaction .

Ro , SSB / La or U1-RNP autoantibodies . 31 These antibodies are found in mothers with autoimmune condi-

is a common skin disorder caused by blockage of sweat ducts . 24 It is commonly seen in hot and humid climates

cally sufficient for tinea corporis , tinea faciei or tinea pedis with first-line therapy being terbinafine 1 % cream once or twice daily for one or two weeks . 26 Systemic antifungals are usually

A well-documented complication of dermatophytosis is a dermatophytid (‘ id ’) reaction . This manifests as a pruritic , monomorphic , symmetrically distributed eczematous eruption

Neonatal lupus erythematosus

Neonatal lupus erythematosus

( NLE ) is a rare autoimmune-medi-

tions such as Sjögren ’ s syndrome or SLE ; however , up to 60 % of cases of NLE arise in otherwise asymptomatic mothers . 32

NLE presents within the first

and is stratified into three subtypes depending on the depth of sweat duct obstruction . 39 Miliaria crystallina presents with 1-2mm superficial blisters that look like beads of sweat . Mil-

required in the treatment of tinea capitis or onychomycosis as topical therapies may not extend into the follicles or nail bed . 29 Urgently refer severe

on the torso , proximal extremities , hairline and ears . 30 This usually occurs after initiation of systemic treatment and does not represent a

ated disease caused by maternally transmitted autoantibodies . The disease affects 10-15 % of newborns of mothers who are positive for SSA /

three months of life with erythematous plaques ( see figure 7 ), ‘ raccoon eyes ’, petechiae and telangiectasia . 33 Other clinical signs include heart

iaria rubra , the most common type , presents as pruritic , erythematous , non-follicular papules and vesicles , usually 2-4mm in diameter . PAGE 22