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The neonates are unique in several ways in comparison with older children and adults which render them highly susceptible to severe, sometimes life threatening dermatological disorders. The neonatal dermatological emergencies are a diagnostic and therapeutic challenge. A wide range of dermatoses such as infections, genodermatoses, metabolic disorde...
Contexts in source publication
Context 1
... and low birth weight infants are particularly predisposed to fatal neonatal infectious disorders. These include staphylococcal scalded skin syndrome (SSSS), necrotizing fascitis, neonatal varicella, neonatal herpes simplex infection (HSV) and cutaneous candidiasis [ Table 7]. ...
Context 2
... scalded skin syndrome follows trivial infective foci elsewhere in the body. The diagnosis is mainly based on typical clinical features [ Table 7]. The culture from lesion is sterile because the infection is caused by exfoliative toxins (ET)-A and ET-B produced by Staphylococcus aureus. ...
Context 3
... rare in neonates, NF is characterized by a fulminant course. The infection starts as a minimal rash, erythema, induration or cellulitis at the site [ Table 7]. Non-invasive imaging techniques help in rapid diagnosis. ...
Context 4
... acquired neonatal varicella presents after 12 days of life. [23] The severity and mortality of neonatal varicella depends on the day of onset of rash in the mother and neonate [ Table 7]. [24,25] Disseminated infection with pneumonia, hepatitis or meningo-encephalitis occurs in 20-50% of cases with a mortality of 20-23%. ...
Context 5
... The neonatal HSV infection is considered as spectrum of disease because of overlapping signs and symptoms. Skin vesicles at or soon after birth are the most common clinical presentation of neonatal HSV infection [ Table 7]. In disseminated disease, vesicles may not develop during entire course of the disease in over 20% of cases. ...
Context 6
... Burn like dermatitis can occur in term infants which precedes systemic involvement. [37] The clinical presentation differs in premature infants weighing <1000g [ Table 7]. Neonatal candidiasis on the other hand manifests after 7 days of life and is localized to oral cavity and diaper. ...
Context 7
... In full-term infants, CCC follows a benign and self-limited course. CCC and neonatal candidiasis can progress to systemic candidiasis in neonates with certain risk factors [ Table 7]. [36] Cultures of blood, urine and cerebrospinal fluid (CSF) should be done whenever systemic infection is suspected, and in all premature infants. ...
Context 8
... Respiratory distress, leukocytosis with immature forms, persistent hyperglycemia and glycosuria, positive cultures from blood, urine or CSF, burn like dermatitis, and extensive instrumentation and invasive procedures are the indications for systemic therapy in CCC. [36] Intravenous amphotericin B is the first line of drug [ Table 7]. Fluconazole 6 mg/ kg/day intravenously can also be used if the neonate develops intolerance to amphotericin B. [41] Newer broad spectrum systemic antifungals like voriconazole (4 mg/kg/day), [42] capsofungin (25 mg/m 2 /day, 1 h infusion) [43] and micafungin (2 mg/kg/day) [44] have been used in combination with or following initial amphotericin B therapy in critically ill neonates with systemic candidiasis. ...
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Citations
... The injured epidermis is a portal of entry for infectious agents and the breakdown of the barrier function of the skin is a risk factor for nosocomial sepsis and death [4][5][6]. ...
Background: Preterms are at risk of systemic infections as the barrier function of their immature skin is insufficient. The long period of hospitalization and the huge number of invasive procedures represent a risk factor for complications. Among the nosocomial infections of the skin, methicillin-resistant Staphylococcus aureus (MRSA) is associated with significant morbidity and mortality. We report a clinical case of cellulitis and abscess in two preterm twins caused by MRSA in a tertiary level Neonatal Intensive Care Unit (NICU).
Case presentation: Two preterm female babies developed cellulitis from MRSA within the first month of extrauterine life. The first one (BW 990 g) showed signs of clinical instability 4 days before the detection of a hyperaemic and painful mass on the thorax. The second one (BW 1240 g) showed signs of clinical instability contextually to the detection of an erythematous, oedematous and painful area in the right submandibular space. In both cases the diagnosis of cellulitis was confirmed by ultrasound. A broad spectrum, multidrug antimicrobial therapy was administered till complete resolution.
Conclusions: Due to the characteristic antibiotic resistance of MRSA and the potential complications of those infections in such delicate patients, basic prevention measures still represent the key to avoid the spreading of neonatal MRSA infections in NICUs, which include hand hygiene and strict precautions, as well as screening of patients for MRSA on admission and during hospital stay, routine prophylactic topical antibiotic of patients, enhanced environmental cleaning, cohorting and isolation of positive patients, barrier precautions, avoidance of ward crowding, and, in some units, surveillance, education and decolonization of healthcare workers and visiting parents.
... This lays forth the need to have a dermatology critical care unit (ICU) that is particularly built for treating dermatological crises. A dermatological emergency is characterized by a cutaneous disease that necessitates hospitalization, intensive treatment, early and fast diagnosis, and monitoring in order to reduce related mortality and morbidity [4]. ...
Numerous people with skin disorders who have real dermatologic crises show up at the emergency room. Family doctors need to be able to identify potentially fatal dermatological disorders quickly since they could be the first to encounter patients with these illnesses. The purpose of this review is to provide guidance for early recognition, help identify distinct symptoms, and enable early diagnosis of emerging dermatological conditions. Necrotizing fasciitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, Rocky Mountain spotted fever, and other possible emergencies that might manifest as dermatological symptoms are examples of these conditions. In this article we will be discussing the dermatological emergencies present at primary care settings and encountered by family physician, recognition and management of those emergencies, referral considerations, role of family medicine in dermatological emergencies and other topics.
... The large amount of proteoglycans also confers greater water content in the newborn's skin, facilitating transdermal absorption of toxins. 8,9 These factors cause skin infections in the neonate to evolve rapidly to severe dehydration, with great risk of complications. In preterm or low birth weight newborns complications and death from skin infections are even more frequent. ...
Bacterial skin infections are especially common in children of tropical regions, varying clinically from a process superficial (such as folliculitis), to a deeper infection (such as necrotizing fasciitis). Infections of skin and subcutaneous tissue are frequent reasons for medical consultations in primary health care services and hospitalization in pediatric patients. In neonates several factors confer an increased susceptibility to bacterial infections of the skin and its complications. Herein, we review essential aspects of the main bacterial skin infections in newborns and nurselings.
... A dermatological emergency is defined as a cutaneous condition, which requires early and prompt diagnosis, continuous monitoring, hospitalization, and intensive care to minimize associated mortality and morbidity. [4] Dermatological emergencies are primarily divided into primary cutaneous emergency, where skin is the primary target, and secondary cutaneous emergency, where skin is affected secondary to a systemic medical or surgical involvement. In both the cases, however, acute skin failure is the end result that lands the patient in the emergency department. ...
Background
A large number of skin diseases have the potential to culminate into potentially fatal “acute skin failure.” The concept of dermatological intensive care unit (ICU) has largely evolved as a result of increased number of emergencies encountered by dermatologists these days. Dermatological emergencies comprise 8–20% of cases presenting to the emergency department. A wide variety of these conditions require a collective effort by intensivists, surgeons, physicians, and nursing staff in association with the treating dermatologist to reduce the associated mortality and morbidity. Dermatology ICU along with state-of-the-art nursing care is required to manage these cases, which result in acute skin failure.
Materials and Methods
A prospective study conducted in a tertiary care center with a round the clock emergency department and a state-of-the-art dermatology ICU over a period of 12 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were evaluated, and their clinical variables were statistically analyzed.
Results
In total, 327 cases were seen in the emergency department, out of which 54 (16.5%) cases were admitted in dermatology ICU, 239 (73.1%) were treated as outpatient cases, and 34 (10.4%) were managed as inpatients in other wards of the hospital. The most common condition in out-patient cases was acute urticaria and angioedema in 71 (29.7%), while vesiculobullous disorders in 16 (29.6%) patients was the most common condition requiring admission in dermatology ICU.
Conclusions
At present, only few studies are available in the literature on the spectrum of dermatological disorders reporting to emergency department, and further requiring intensive care under ICU setting. This prospective study highlights the varied patterns of dermatosis reporting to emergency outpatient department and those managed in the ICU.
... However, it has been seen that dermatological conditions comprise approximately 5-8% of all cases presenting to the emergency department. 1 A dermatological emergency is defined as a skin condition which requires early diagnosis, hospitalization, monitoring, and intensive care to minimize associated morbidity and mortality. 2 Dermatological emergencies can be divided into primary, where the skin is the primarily involved organ, or associated with medical and surgical emergencies, where cutaneous lesions indicate impending or underlying severe systemic involvement. Mortality and morbidity due to dermatological causes can occur due to sudden, severe alterations in the anatomy and physiology of skin and can lead to acute skin failure. ...
Background:
Although dermatology is largely considered as an outpatient specialty, dermatological conditions comprise 5-8% of cases presenting to the emergency department. The need for a dermatological intensive care unit is widely acknowledged due to the increasing incidence of acute skin failure. Very few studies have been done to characterize the common conditions seen in the emergency department and intensive care units. We undertook this study to analyze the spectrum of dermatological conditions presenting to the emergency department and the clinical profile of patients admitted to the intensive care unit.
Methods:
A prospective study was conducted for 9 months. Patients requiring primary dermatological consultation in the emergency department and patients admitted in the dermatology intensive care unit were examined, and their clinical variables were statistically analyzed.
Results:
A total of 248 cases were seen in the emergency department, out of which 72 (29.1%) cases were admitted and 176 (70.9%) were treated in the emergency department on an outpatient basis. The most common condition seen in non-admitted patients was acute urticaria (28.9%). The most common cause for admission in patients presenting to the emergency department was erythroderma (23.6%). Sixty-two patients were admitted to the intensive care unit, the most common diagnosis being erythroderma (40.3%).
Conclusions:
This prospective study aimed to provide an insight into the types of cases evaluated in the emergency department by dermatologists in a large tertiary care hospital in coastal Karnataka in South India.
... Transepidermal water loss (TEWL) is the normal, constitutive loss of water vapor from the skin in the absence of sweat gland activity (3). TEWL plays an important role in heat exchange between the body and the environment and contributes to 70% of insensible water loss in newborns, reflecting skin immaturity and the newborn's larger surface area:weight ratio (4). ...
Background
Transepidermal water loss (TEWL) is the normal, constitutive loss of water vapor from the skin in the absence of sweat gland activity. It is regarded as one of the most important parameters for characterizing skin barrier function, and the values are dependent on multiple variables. The objective of this study was to evaluate TEWL in neonates using a closed- chamber system, and determine if there is a variation of TEWL with the mode of delivery, pre-term birth, low birthweight or phototherapy.Methods
This prospective study was conducted in 104 healthy neonates, 30 neonates in the Neonatal Intensive Care Unit (NICU) and 40 adults using a noninvasive, closed- chamber system (VapoMeter™).ResultsA statistically significant difference in TEWL was noted between newborns and adults. No remarkable difference in TEWL was seen between boys or men and girls or women or those born via normal vaginal birth and caesarean section, but TEWL was significantly higher in preterm and low birthweight neonates. Significantly higher TEWL was noted from the antecubital fossa of the neonates who received phototherapy when compared with six other sites.Conclusions
The closed- chamber system is an acceptable alternative to the more widely used open-chamber system. The higher mean TEWL in neonates suggests that the epidermal barrier is still adapting to extrauterine life, making newborn skin more sensitive and requiring appropriate, age adapted care.
... Possibility of Leiner's disease may be relevant only after ruling out other causes of neonatal erythroderma. [96] Complications of neonatal erythroderma include inhibited respiration and sucking due to collodion membrane; and infections, fluid loss, hypernatraemic dehydration, electrolyte imbalance and thermal instability as a result of fissuring and barrier dysfunction after the peeling off (in 2 or more weeks) of this membrane. Except in Netherton syndrome, systemic retinoids are salutary in the treatment of ichthyoses; however, their propensity to cause skin fragility and decrease barrier competence, necessitates consideration of risk/benefit ratio. ...
... Hereditary protein C deficiency, more marked in the homozygous form, can be reliably diagnosed by estimating protein C activity. [96] Acute infectious purpura fulminans (PF) has a mortality of 50% despite aggressive management with third generation cephalosporins, immediate heparinization, fresh frozen plasma (15 ml/kg every 12 h) infusion resuscitation and use of prostacycline, a thromboxane A 2 antagonist – initially 5 ng/kg/min, escalated and maintained at 15 ng/kg/min for 48 h. Mortality is 100% in hereditary neonatal PF unless adequate oral anticoagulation is maintained throughout life. ...
... Various risk factors like <27 weeks of gestation age, Wt <1000 g, intrauterine device, cervical sutures, invasive procedures, and extensive instrumentation have been reported. [7] The role of maternal steroids or immunodefi ciency in the infant is controversial. [8] In the present case, cervical encirclage was done for cervical incompetence by McDonold's method at 16 weeks of pregnancy. ...
Congenital candidiasis (CC) is a rare disease with less than 100 cases being reported in the literature. It presents within six days of life with manifestations ranging from localized skin disease to systemic involvement in the form of respiratory distress, sepsis, and death. We report a neonate who presented with diffuse pustular eruption on erythematous background involving face, trunk, and palms within 24 h after birth. Candida albicans was identified in 10% potassium hydroxide (KOH) smear and culture from the pustules. Intravenous fluconazole and topical ketoconazole were given and the condition improved completely in two weeks. CC is rare and needs to be differentiated from other conditions presenting with pustular lesions at birth in order to avoid complications. Early diagnosis and prompt treatment of this condition is important as untreated cases carry a mortality rate of 8-40%.
Erythroderma (E), first described by Hebra in 1868, is a reaction pattern, characterized by diffuse and confluent erythema with desquamation affecting most of or the entire body surface. E is usually accompanied by systemic manifestations including several metabolic changes. E may be the morphologic presentation of a variety of cutaneous and systemic diseases or, ultimately, the evolution of different skin disorders. The treatment of E includes systemic treatment that varies according to the underlying condition.
BACKGROUND: Dermatological emergency is a condition requiring immediate identification and treatment to reduce mortality and morbidity. There are several dermatoses resulting in emergency room (ER) visits frequently demonstrated by the geriatric population. However, there is a lack of data about elderly with dermatological presentation seen at the ER in Indonesia. AIM: This retrospective study aims to identify the prevalence of dermatological emergency cases in the elderly at three national referral hospitals in Indonesia within 3 years. METHODS: The sample was geriatric patients who came and/or were consulted by the ER to dermatology and venereology (DV) department. The data (e.g., age, sex, history taking, physical findings, and diagnoses) were collected from medical record from each hospital and presented as a descriptive data. RESULTS: This study showed that there were only 37% of all geriatric emergency dermatological consultations from 2017 to 2020. CONCLUSION: This study concluded that there were more than half non-emergent cases of 3-year period consultation. This condition may raise the need of better training about true emergency and standardized curricula of emergency dermatological presentations in geriatric patients.
