Cutaneous lesions in new born
S P Dewan
470, Basanth Avenue, Amritsar -143001
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Sachdeva M, Kaur S, Nagpal M, Dewan S P. Cutaneous lesions in new born . Indian J Dermatol Venereol Leprol 2002;68:334-337
AbstractFive hundred unselected newborn babies delivered in the Department of Obstetrics and Gynaecology, Unit II of SGBT Hospital attached to Government Medical College, Amritsar during April 2000 to October 2000 were examined for cutaneous lesions daily for the first five days after birth. Different cutaneous lesions were seen in 474(94. 8%) newborns. The physiological skin changes observed in order of frequency were Epstein pearls in 305(61%), Mongolian spot in 301(60. 2%), superficial cutaneous desquamation in 200(40%), icterus in 128(25. 6%), milia in 119(23. 8%), sebaceous gland hyperplasia in 107 (21. 4%), occipital alopecia in 94(18. 8%), lanugo in 72(14. 4%), peripheral cyanosis in 47(9. 4%), breast hypertrophy in 29(5. 8%) and miniature puberty in 28(5. 6%) newborns. Of the transient non-infective skin diseases, erythema toxicum neonatorum was observed most commonly in 105(21 %), followed by miliaria rubra in 103(20. 6%) and acne neonatorum in 27(5. 4%) newborns. The naevi and other developmental defects in the descending order were salmon patch in 69(13. 8%), congenital melanocytic noevi in 10(2%), accessory tragi in 3(0.6%), spina bifida in 2(0.4%), hydrocephalus in 1(0.2%) and poliosis in 1(0.2%) newborns. Cradle cap was the only dermatitis observed in 50(10%) newborns. One (0.2%) case each of Harlequin ichthyosis and labial cyst was seen.
A host of aberrations varying from physiological and transient to grossly pathological changes are seen in the skin of a neonate. But the majority of the newborn cutaneous lesions are usually physiological, transient and self limited and thus require no therapy. The available literature on neonatal skin lesions in our country is meager. There are very few reports in the Indian literature regarding the cutaneous lesions seen in the newborn. Therefore, the present study was undertaken to review the pattern of neonatal dermatoses in this part of the country.
Materials and Methods
Five hundred unselected newborn babies delivered at the Department of Obstetrics and Gynaecology, Unit II of SGBT Hospital attached to Government Medical College, Amritsar during April 2000 to October 2000 were studied. The relevant history was recorded especially age of the mother, occupational status, educational status, income status and rural or urban background of the parents. In addition, parity of the mother, history of abortion, history of maternal illness during pregnancy and the mode of delivery were noted. The neonate was examined thoroughly including general physical, systemic and dermatological examinations and all the details were recorded. The sex, birth weight and age in hours at the time of first examination were recorded in each case. The neonate was examined daily for five days and all dermatological findings were noted. The lesions were studied to assess the relationship between their occurrence and the various maternal/ neonatal aspects. Simple non-invasive investigations such as examination of scrapings for candida, pus swabs for bacterial culture, smears from pustules for Gram staining and Tzanck smear from vesicles were performed whenever they were required.
Of the 500 newborns, 287(57. 4%) newborns were males and 213(42. 6%) were females. Equal number of neonates i.e. 250(50%) each was delivered by normal vaginal delivery and caesarian section. There were 451(90. 2%) term and 49(9. 8%) preterm deliveries. 271(54. 2%) newborns weighed more than 2. 5 kg, 202(40. 4%) neonates weighed between 2. 0-2. 5 kg and 27(5. 4%) weighed less than 2 kg.
The incidence of cutaneous lesions as observed in this study are shown in [Table - 1]
The maximum number i. e. 262(52. 4%) mothers were in the age group of 21-25 years, 129(25. 8%) mothers in the age group of less than 20 years and the remaining i. e. 109(21. 8%) mothers were in the age group of 26-40 years. 315(63%) mothers were multigravida and 185(37%) mothers were primigravida. 231(46. 2%) mothers had associated illness during pregnancy. [Figure - 1]
The appreciation of normal phenomena and their differentiation from the more significant cutaneous disorders of the neonate is critical. In the present study 474(94. 8%) neonates had one or more cutaneous lesions.
In our study Epstein pearls were the most frequently observed lesions, present in 305(61 %) of babies. The incidence in the present study is nearly comparable with the incidences observed in other studies. ,, These were more among males compared to females and more among term babies. A higher incidence was seen in multipara and in babies weighing more than 2. 5kg. Illness in the mother during pregnancy does not appear to influence their development and there was no correlation to the mode of delivery. [Figure - 2]
In our study Mongolian spots were seen in 301 (60. 2%) babies. The frequency of Mongolian spots in our study is almost comparable with those of other Indian workers. ,,,, Higher inci-dence in black babies, Asiatic babies, La-dino babies and Mongo-lians point to-wards its ra-cial varia-tioin. ,,, [Figure - 3] These were seen more commonly in males and more among term babies. A higher incidence was observed in multipara and in babies with more birth weight. There was no relation to ma-ternal illness or mode of delivery.
Superficial cu-taneous desquamation was seen in 200 (40%) newborns. The incidence of superficial cu-taneous desq-uamation as observed in other studies varies from 7. 2%-83%. .,,, The variations in the different observations may be attributed to the fact that the babies were followed up for more than 5 days in some of the studies. It was observed more among males compared to females and more among term babies. A lower incidence was seen in primigravida and in babies weighing less than 2kg. [Figure - 4]
Milia were seen in 119(23. 8%) cases. This is ap-proximately comparable to the inci-dence ob-served by other Indian workers. , A higher inci-dence was seen in term babies which has also been noted by other workers These were seen more commonly in babies weighing more than 2. 5kg and in multi-para. [Figure - 5]
Sebaceous gland hyperplasia seen in 107 (21. 4%) cases is com-parable with the result of Dash et al.  It was seen more commonly in babies deliv-ered by nor-mal vaginal route, more in multipara and in babies weighing more than 2. 5kg.
Lanugo was seen in 72 (14. 4%) cases in our study which is comparable to the incidence observed by Nobbay et al.  Predictably a high percent of them were preterm (61. 2%) as reported in other studies. . A higher incidence in babies weighing less than 2. 5kg may be due to its preponderance in preterm babies. It was more common in normal deliveries and in multipara. [Figure - 6]
A total of 105(21 %) cases of erythema toxicum neonatorum were seen in our study which is comparable to the incidence observed by other workers. ,,, All the babies were born at term which is in concurrence with another study.  A higher incidence has been noted in term babies by other workers. ,,, A higher incidence was observed in multipara and in babies with more birth weight.
The number of cases of miliaria rubra was 103(20. 6%) which is comparable with the results of Dash et al.  The incidence in other studies varies from 2. 6% to 9. 6%,, which may be attributed to climatic variation. A higher incidence was found in multipara and in term babies. It was seen more commonly in babies delivered by caesarian section and in babies with more birth weight.
Salmon patch was seen in 69(13. 8%) cases in our study. The incidence of the lesion was, low in the present study as compared to the other studies. ,,,,, Its incidence was low in primigravida and in low birth babies.
Cradle cap was seen in 50(10%) cases. Dash et al have reported a lower incidence of 4%. It was seen more commonly in term babies and in high birth weight babies.
A chance finding in out study was that of a case of Harlequin ichthyosis and a case of labial cyst.
The study of newborn skin is interesting. It is important to be aware of the fact that most of the skin lesions in the newborn are innocent and transient. Therefore these should be differentiated form other more serious skin conditions, which will avoid unnecessary therapy to neonates and patents can be assured of good prognosis of these skin manifestations.
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