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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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%).
Skin lesions; Physiological; Pathological; Neonates
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.
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.
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.
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.
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.
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).
|Examined neonates ( N =500)||Number||%|
|Skin Lesions seen||24||04.8|
|Skin Lesions Present||476||95.2|
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.
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 . 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 .
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  which has almost same findings except desquamation as the lowest frequency of about 21% and erythema toxium has higher frequency of 68%. Iranian study  was near to our study except erythema toxium as the lowest frequency of about 11%.
Japanese study  was also near to our study with 40% frequency of it; while Indian study reported 20%  pageant  and the finish study  reported erythema toxicum frequency 34% and 70%. Mallory 1991  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  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 , 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  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%.
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.
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.
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.