Maria Giovanna Paglietti (Italy)
Bambino Gesù Children's Hospital IRCCS, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Academic Department of Pediatrics.Author Of 1 Presentation
AN UNUSUAL RASH ON A HEALTHY NEWBORN'S BACK
Abstract
Title of Case(s):
AN UNUSUAL RASH ON A HEALTHY NEWBORN'S BACK
Background:
A healthy full-term girl, born by vaginal delivery after an unremarkable pregnancy, on the fifth day of life presented a thick hyperkeratotic and erythematous nodules on her back (figure 1)
.
Case Presentation Summary:
In the next 30-days, several lesions spread to the abdomen and the extremities. Trough time each lesion become thicker and the erythema extended to the surrounding skin (figure 2)
. The mother received a diagnosis of stress dermatitis during pregnancy and reported a slight and temporary improvement of the lesions with topical betamethasone plus gentamycin. The girl was admitted at the age of 35 days, she was well appearing and no other symptoms. Dermatoscopy of the lesions showed jetliners signs and scabies mites. Therefore, a diagnosis of neonatal scabies was made. We treated her and her cohabitants with a cream containing sulfur 18% and potassium carbonate 8%, obtaining complete and definitive healing. Her and all the cohabitants received two courses of three consecutive days of cream. Moreover, wears and house underwent disinfestation procedures.
Key Learning Points:
Neonatal scabies typically presents as a long-lasting nodular eruption and may be overlooked or easily underwent misdiagnosis. Therefore, patients affected by neonatal scabies often receive topical steroids that may lead to an apparent partial response due to reduction of the eosinophilic inflammation as in our case. In new-borns even the face can be involved by scabies mites, and bacterial superinfection may be severe requiring systemic antibiotics. Nearly always, infestation involves all cohabiting and they should be treated regardless of their status as well as the house and wears. Therefore, a family history of hitching should be valued beyond the diagnosis received by the cohabitants. The diagnosis of neonatal scabies is frequently missed or delayed in absence of a clear family history. Moreover, the histology, if performed, is often inconclusive.