Paediatric Dermatology

Question 1

How does neonatal candida differ from congenital candidiasis

Answer 1

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
-

Question 2

What are risk factors for congenital candidiasis?

Answer 2

Foreign body in uterus or cervix eg. Retained IUD, cervical cerclage
Premature delivery
Maternal hx of vaginal candidiasis (thought to be secondary ascending infection)

Question 3

Who is at greater risk of disseminated systemic candidiasis

Answer 3

Premature infants <27wk and <1.5kg

Question 4

How would you manage NEONATAL candidiasis

Answer 4

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

Question 5

How would you manage CONGENITAL candidiasis

Answer 5

• 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

Question 6

T/F - Erythema toxicum neonatorum occurs in half of all premature infants

Answer 6

False - half of all full term neonates

Question 7

T/F - ETN could be an inflammatory response to microbial colonisation of the follicle in the first few days

Answer 7

True

Question 8

What are the five components of erythema toxicum neonatorum

Answer 8

Erythematous macules
Wheals
Small pustules
Vesicles
Papules usually measure 1-2mm diameter, reminiscent of a flea bite

Question 9

T/F mechanical irritation can precipitate new lesions of ETN

Answer 9

True

Question 10

Erythema toxicum neonatorum frequently involves palms and soles T/F

Answer 10

False - almost always SPARES the palms and soles

Question 11

Sterile transient neonatal pustulosis is a term to encompass the ETN-TNPM spectrum

Answer 11

True

Question 12

Neonatal cephalic pustulosis occurs in the first 2-3 weeks of life

Answer 12

True

Question 13

Neonatal cephalic pustulosis spontaneously resolves over weeks to months

Answer 13

True

Question 14

Which of these are itchy in neonates:

• erythema toxicum neonatorum
• transient neonatal pustular melanosis
• scabies
• acropustulosis of infancy

Answer 14

• F
• F
• T
• T

Question 15

Acropustulosis of infancy usually resolves by 1 year

Answer 15

False , by 3 years

Question 16

Acropustulosis of infancy is non pruritic

Answer 16

False, itchy

Question 17

Acropustulosis of infancy smear of pustule contents demonstrates neuts but not eos

Answer 17

False — can occasionally see eos

Question 18

Congenital erosive and vesicular dermatosis healing with reticulated supple scarring is thought to be associated with maternal HSV

Answer 18

True

Question 19

Which diseases can be caused by transplacental transfer

Answer 19

• neonatal pemphigus (vulgaris or foliaceus)
• neonatal pemphigoid gestationis
• neonatal LE

Question 20

Causes of blueberry muffin baby

Answer 20

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