A Study On Neonatal Dermatosis In A Tertiary Care Hospital Of Western Uttar Pradesh, India

Gagan Agarwal^1*, Vijay Kumar¹, Sartaj Ahmad², Kapil Goel³, Parul Goel⁴, Ashish Prakash⁵, Ajay Punj¹ and Meenal Garg⁶

¹Assistant Professor of Pediatrics, Subharti Medical College, Meerut, Uttar Pradesh, India

²Department of Medical Sociology, Subharti Medical College, Meerut, Uttar Pradesh, India

³Department of Community Medicine, Subharti Medical College, Meerut, Uttar Pradesh, India

⁴Department of Biochemistry, Subharti Medical College, Meerut, Uttar Pradesh, India

⁵Professor of Pediatrics, Subharti Medical College, Meerut, Uttar Pradesh, India

⁶Senior Resident OBG, AIIMS, New Delhi, India

*Corresponding Author:

Gagan Agarwal
Assistant Professor Pediatrics
Subharti Medical College
Meerut, Uttar Pradesh, India
E-mail: drgagan15@gmail.com

Received date: July 31, 2012; Accepted date: September 22, 2012; Published date: September 24, 2012

Citation: Agarwal G, Kumar V, Ahmad S, Goel K, Goel P, et al. (2012) A Study on Neonatal Dermatosis in a Tertiary Care Hospital of Western Uttar Pradesh India. J Community Med Health Educ 2:169. doi: 10.4172/2161-0711.1000169

Copyright: © 2012 Agarwal G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

The aim of this study is to assess the frequency of both physiological and pathological cutaneous lesions in first seven days of life in a tertiary care hospital of western uttar pradesh. Overall 500 neonates either inborn or attending paediatric opd/ clinic and delivered in the hospital were included in the study. The study took 6 months, consent from parents of those neonates were taken. Clinical examination, dermatological examinations were carried out to check their eligibility to enter this study and to diagnose the skin lesions. Consultations to dermatologists were done in the beginning of the study, especially, in the doubtful cutaneous lesions. Skin lesions were present in 476 (95.2%) neonates. Of these 6O neonates (12%) have pathological lesions, 430(86%) had only physiological lesion, while 14 neonates (2.8%) had both physiological and pathological lesions. Of physiological lesions epstein pearls were most common (78%) second most common lesion was mongolion spots (65%), desquamation was seen in 52% cases, & milia (42%). Pathological lesions pustulosis was most common seen in 28% cases, second most common lesion was oral thrush (26%).

Keywords

Skin lesions; Physiological; Pathological; Neonates

Introduction

Dermatosis in neonatal period is very common and important cause of parental anxiety seeking paediatric consultation. The majority of neonatal cutaneous lesions are usually physiological, transient and self limited, while only are pathological requiring treatment. However, it is important to indentify and diagnose them correctly so as to avoid unnecessary diagnostic or therapeutic interventions. Few lesions can be cutaneous manifestation of potentially fatal systemic condition, so early diagnosis of pathological neonatal dermatosis helps in initiating early specific therapy. The aims of study were to ascertain the common dermatosis among neonates (both physiological and pathological) within 7 days of life from rural and suburban background attending paediatric OPD / vaccination and delivered in our institute.

Objective

To study the prevalence of neonatal dermatosis in new-borns within first seven days of life attending paediatric OPD, vaccination clinic and delivered in institute which is a tertiary care hospital.

Inclusion criterion

Full term neonates with birth weight >2.5 kg either inborn or who are attending paediatric OPD / vaccination clinic.

Less than 7 days of life.

Exclusion criterion

Preterm and IUGR (Intra Uterine Growth Retardation) neonates.

Neonates born to mother with any medical illness.

Neonates born to mother with history of drug and alcohol abuse.

Neonates with gross congenital malformations.

Neonates with history of hospitalization.

Materials and Methods

A prospective clinical study was done involving 500 neonates who presented to us in first 7 days of life in OPD/ vaccination room and inborn over a period of 6 months. Informed consent was taken from neonate’s mother or guardian.

After taking relevant maternal as well as neonatal history, the entire skin surface of the neonate, including the scalp, mucous membranes, genitilia, hair and nails were examined in proper ambient temperature and adequate light. Proper hand washing and sterilisation procedure were done before examination of neonate. All physiological and pathological skin changes were observed, recorded and analysed. Clinical examination of mother or any other close contact was recorded when required. Diagnosis of skin lesions was done by paediatrician under clinical impression, in few cases consultation with dermatologist were taken to clarify the diagnosis.

Results

500 babies were examined over a period of 6 months. Skin lesions were present in 476 (95.2%) neonates. Of these 60 neonates (12.60%) have pathological lesions, 402 (84.45%) had only physiological lesion, while 14 neonates (2.95%) had both physiological and pathological lesions (Table 1).

Table 1: Examined Neonates in a Tertiary Care Hospital.

Table 2: Types of Skin Lesions.

Of physiological lesions Epstein pearls were most common (78%) second most common lesion was Mongolian spots (65%), desquamation was seen in 52% cases, milia (42%), sebaceous hyperplasia in 40% cases, miliria (40%), salmon patch (32%) and erythema toxium (22%).

Of pathological lesions pustulosis was most common seen in 28% cases, second most common lesion was oral thrush (26%), diaper rash was found in 5% cases and cellulitis in 4% cases.

Discussion

Skin rashes are common in neonate and can cause parental anxiety. Many of these are transient and physiological, but some may require additional work up rule a more serious disorder [1]. Hence, it is important for the paediatrician to recognize these physiological states and to differentiate these from pathological states. Benign dermatoses in new-borns must be distinguished from more serious disorders with cutaneous manifestations, and recognition of these dermatoses allows the physician to proceed appropriately, reassure the parents and initiate further evaluation or treatment as necessary [2].

In our study we found that Epstein pearls, Mongolian spots, desquamation, and milia are the skin lesions which are commonly seen in the neonates included in this study. While in Jordian study [3] which has almost same findings except desquamation as the lowest frequency of about 21% and erythema toxium has higher frequency of 68%. Iranian study [4] was near to our study except erythema toxium as the lowest frequency of about 11%.

Japanese study [5] was also near to our study with 40% frequency of it; while Indian study reported 20% [6] pageant [7] and the finish study [8] reported erythema toxicum frequency 34% and 70%. Mallory 1991 [9] conducted a survey in USA and found that each and every neonate has one form of skin lesion early after delivery. He found that the commonest lesions were as follows: desquamation, Epstein pearls, sebaceous hyperplasia, milia, toxic erythema, salmon patch, hypertrichosis and the Mongolian spots. This result to a greater extent resembles our study.

In the prevalence survey conducted in Australia by Rivers [10] their results were as follows, desquamation (65%), followed by Epstein pearls (56%), sebaceous hyperplasia (48%), milia (36%), but their results regarding erythema toxicum was (34%) and salmon patch (32%). Their results resemble to great extent those of the American survey.

A similar result was seen at the French study [11], which was conducted at the maternity ward of Brest university hospital. Erythema toxicum was the commonest neonatal skin lesion with a rate of 103 /142; they suggested that erythema toxicum is more common in the Caucasian population than coloured population.

In contrast, the Indian study [6] scored the lowest rate for frequency of erythema toxicum, which is (20%), which may give a clue that a racial factor may came into play.

None, of the above study takes in consideration the incidence of pathological lesions, which are not very uncommon in neonates especially in circumstances where hygiene conditions are not very good. In our study we found that pathological lesions were also very frequent in our clinical setup with incidence of 12%.

Conclusion

Skin lesions are very common in neonatal period. Most of the skin lesions in this period are innocent and transient but pathological lesions are not very uncommon especially in our settings where hygienic conditions are not very healthy. So any cutaneous lesion during this period should be carefully examined and should be differentiated from more serious skin conditions in order to avoid unnecessary therapy to neonates and to reassure parents about the good prognosis of these skin manifestations.

Recommendation

We recommend early are careful evaluation of neonatal dermatitis to avoid unnecessary anxiety to parents and to rule out pathological lesions, which can lead to more serious health issues in neonates.

Acknowledgements

We thank parents of all neonates who were part of this study for giving their consent and cooperation. We will also like to thank the medical and nursing staff of department of paediatrics and department of obstetrics and gynaecology in our institute for their help and cooperation in conducting this study.

References

1. Manish, Pahwa Pooja, Jain RK (2008) Transient neonatal dermatosis- Mostly physiological. Journal of dermatology 22: 10-13.
2. Treadwell PA (1997) Dermatosis in newborns. Am Fam Physician 56: 443–450.
3. Khaled A. Al-Dahiyat (2006) Neonatal Skin lesions in Jordan, Study of Consecutive 500 neonates at King Hussein Medical Center. Calicut Medical Journal 4: e1
4. Moosavi Z, Hosseinni T (2006) One-year survey of cutanous lesions in 1000 consecutive Iranian newborns, Pediatrics dermatol 23: 61–63.
5. Hidano A., Parwoko R, Jitsukawa K (1986) Statistical survey of skin Changes in Japanese neonates. Paediatr dermatol 3: 140–144.
6. Nanda A, Kaur S, Bhakoo ON, Dhall K (1989) Survey of cutaneous lesions in Indian newborns, paediatr dermatol 6: 39–42.
7. Prigent F, Vige P, Martinemt C (1991) Coetaneous lesions during the first week of life in 306 consecutive newborns infants, Ann Dermatol Venereol 118: 697–699
8. Karvonen SL, Vaaljalaht P, Marenk M, et al. (1992) Birthmarks in 4346 Finnish newborns, Acta Derma Venereol 72: 55–57.
9. Mallory SB (1991) Neonatal skin disorder, Paediatr clin north Am 38: 745–761.
10. Rivers JK, Frederiksen PC, Dibdin C. (1990) A prevalence survey of dermatoses in the Australian neonate, J Am Acad Dermatol 23: 77-81.
11. Plantin P, Delaire P, Gauanon J, Boog G, Guillet G (1990) Benign cutaneous lesions observed within the 1st 48 hours of life in 874 infants born at a maternity ward of a university hospital. Apropos of 148 cases. Ann Dermatol Venereol 117: 181-184.