The management of neonates with blistering requires a disciplined approach that includes a broad differential diagnosis of common and rare disorders. For the purposes of this chapter, blistering is broadly defined as primary fluid-filled lesions, such as vesicles, bullae, and pustules, as well as resultant secondary lesions, such as erosions (see Figure 121-1). Blistering lesions are not uncommon in the neonate, and although the majority of etiologies are relatively benign, the rare, life-threatening subset requires that thorough evaluations be considered for all affected neonates.
A, A vesicle is a fluid-filled lesion 1 cm or less in size; B, the term bulla refers to a larger blister. Vesiculopustules (C) and pustules are filled with purulent fluid. Note the cloudy-to-white appearance of these lesions. D, Erosions result from loss of the epidermis and are often secondary to prior bullous lesions. This neonate with epidermolysis bullosa has a large congenital erosion.
Over 40 different neonatal disorders can present with bullous or erosive skin changes.1 A useful diagnostic algorithm divides these conditions into infectious and noninfectious etiologies, with the latter further divided based on localized or generalized distribution, followed by predominant lesion morphology (see Figure 121-2).2,3 A thorough history, including the prenatal and neonatal course, and physical examination will direct the initial evaluation and treatment. The maternal history should include maternal and family history of skin and mucous membrane disease, prenatal care, maternal serologies, maternal illness, and delivery course (including delivery method and duration of rupture of membranes). If the maternal history is positive for skin or mucous membrane disease, maternal examination is indicated. Neonatal history should include gestation, symptoms of illness, prior procedures, medications, feeding history, neurologic status, and vital sign instability. Skin and mucous membrane evaluation should note lesion distribution, configuration, and morphology. Evaluation of other organ systems may be warranted as indicated (see Table 121-1).1,2
A diagnostic flowchart for neonates with bullous and erosive lesions, based on the predominant lesion morphology: B, blisters; P, pustules, E, erosions.
Table 121-1Considerations in the History and Physical Examination of the Neonate With Blisters |Favorite Table|Download (.pdf) Table 121-1Considerations in the History and Physical Examination of the Neonate With Blisters
|Family history ||Skin or mucous membrane disease in other relatives or family members |
|Maternal and prenatal history |
History of maternal skin or mucous membrane disease
Prenatal care and course
Maternal serologies (eg, HIV, ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.