Differential Diagnosis > Morphology > Reaction Patterns > Vesicobullous > Vesicles/Pustules in the Newborn

Vesicles/Pustules in the Newborn

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tests:  Tzank, KOH, gram stain

 

 

hmtoggle_plus1neonate = birth to four weeks
•incontinentia pigmenti
•neonatal scabies
•bullous impetigo
•transient neonatal pustular melanosis often black infants, palms and soles, collarettes of scale
•erythema toxicum neonatorum resolves spontaneously within ten days, follicular therefore spares palms and soles
•neonatal HSV
•congenital candidiasis (birth to 1 week) oral mucosa, diaper area
•congenital syphilis
•distinct: miliaria crystallina

 

hmtoggle_plus1infant (>2months old)
•eosinophilic pustular folliculitis (rare; may represent a more persistent form of erythema toxicum neonatorum)
•scabies
•bullous impetigo

 

 

•rare and distinct: epidermolysis bullosa, congenital bullous ichthyosiform erythroderma, bullous disease of childhood

 

 

vesicopustules on the palms and soles:

•neonate:  scabies, transient neonatal pustular melanosis, bullous impetigo, but not... erythema toxicum neonatorum - which is follicular and therefore spares the palms and soles
•infant: scabies, acropustulosis of infancy, dyshidrosis, bullous impetigo

 

 

hmtoggle_plus1summary chart:

 

Age

Incidence

Symptoms

Palms And Soles

Tzank

Erythema Toxicum Neonatorum

first 2 days

very common

 

 

spares

eosinophils

Transient Neonatal Pustular

Melanosis

in utero; at birth

uncommon

none;  collarettes and dark spots

 

characteristic

PMN’s

Infantile Acropustulosis

2-10 months

 

pruritic; recurrent episodes (every 2 weeks)

characteristic

 

Neonatal Scabies

neonate

 

 

characteristic