Paediatric Dermatology Flashcards
How does neonatal candida differ from congenital candidiasis
Neonatal candidiasis - first week of life, mainly nappy area and oral mucosa
- characteristic pink red patches with satellite papules and pustules are characteristic
Congenital candida - widespread, usually evident at birth
- SPARES nappy and ORAL MUCOSA
- often involves PALMS AND SOLES
- sometimes can appear as late as sixth day of life
- erythematous papules followed by pustules and desquamation
-
What are risk factors for congenital candidiasis?
Foreign body in uterus or cervix eg. Retained IUD, cervical cerclage
Premature delivery
Maternal hx of vaginal candidiasis (thought to be secondary ascending infection)
Who is at greater risk of disseminated systemic candidiasis
Premature infants <27wk and <1.5kg
How would you manage NEONATAL candidiasis
Topical anti yeast medication eg. Resolve/Canesten
- even if localised involvement, premature infants with low birthweight <1.5kg need close monitoring with cultures of :
- blood
- urine
- CSF
- treatment with parenteral antifungals needs consideration if signs of systemic infection
How would you manage CONGENITAL candidiasis
- if disseminated —> need parenteral antifungals after cultures obtained. Particularly premature <27wk and low BW
- if more advanced gestational age, with no evidence of systemic inv, can start topicals as per the neonatal form
- regardless of age, systemics are indicated in:
1. Respiratory distress
2. Elevated WCC with left shift
3. Other signs of systemic infection
—> fevers
—>impaired respiratory function
—> HSM
—> abnormal LFTs
—> CNS — candidal meningitis
Treat with amphotericin B or fluconazole, or flucytosine which is synergistic with amphotericin B
T/F - Erythema toxicum neonatorum occurs in half of all premature infants
False - half of all full term neonates
T/F - ETN could be an inflammatory response to microbial colonisation of the follicle in the first few days
True
What are the five components of erythema toxicum neonatorum
Erythematous macules Wheals Small pustules Vesicles Papules usually measure 1-2mm diameter, reminiscent of a flea bite
T/F mechanical irritation can precipitate new lesions of ETN
True
Erythema toxicum neonatorum frequently involves palms and soles T/F
False - almost always SPARES the palms and soles
Sterile transient neonatal pustulosis is a term to encompass the ETN-TNPM spectrum
True
Neonatal cephalic pustulosis occurs in the first 2-3 weeks of life
True
Neonatal cephalic pustulosis spontaneously resolves over weeks to months
True
Which of these are itchy in neonates:
- erythema toxicum neonatorum
- transient neonatal pustular melanosis
- scabies
- acropustulosis of infancy
- F
- F
- T
- T
Acropustulosis of infancy usually resolves by 1 year
False , by 3 years
Acropustulosis of infancy is non pruritic
False, itchy
Acropustulosis of infancy smear of pustule contents demonstrates neuts but not eos
False — can occasionally see eos
Congenital erosive and vesicular dermatosis healing with reticulated supple scarring is thought to be associated with maternal HSV
True
Which diseases can be caused by transplacental transfer
- neonatal pemphigus (vulgaris or foliaceus)
- neonatal pemphigoid gestationis
- neonatal LE
Causes of blueberry muffin baby
CHIMD
— Congenital infections: TORCH screen , HSV/VZV, rubella, syphilis and parvovirus
— Haem: Twin to twin transfusion , haemolytic disease of the newborn
— Immune : neonatal lupus
—Malignant: LCH, congenital leukaemia , rhabdomyosarcoma
— Drugs: EPO
