re: What is this newborn rash?

[skaushik]

Please let me know what this rash is? A full term baby born vaginally. No complications during pregancy. Mom GBS positive, inadequate treatment. She had borderline low platelets (cause not known). Baby was pale, hypoperfused at birth needing fluid bolus. Admitted for "rule out sepsis". A rash (see attached) noted at birth. Itchy. Blanching with pressure. Papulo-erythematous over face, trunk. None noted on palms, soles, diaper area. Some part of rash appeared scaly after 24 hours.

Any ideas what this rash is?

Baby's CBC was normal with normal platelet count.

[Stefan Johansson]

Looks like erythema toxicum neonatorum ?

[hehady]

Erythema toxicum is the most probable diagnosis. However this rash is usually not apparent at birth and starts 48 hr after birth

[selvanr4]

could be GBS induced. Please do CRP and blood culture.

[Stefan Johansson]

Another possibility is neonatal pustular melanosis, also a self-limiting condition that can be present at birth.

I think this is some kind of "relative" to the much more common eryth toxicum neonatorum.

Here a link to emedicine: http://emedicine.medscape.com/article/909753-overview

Correct or not, when I suspect this diagnosis, I check CRP and blood counts and want to see normal results there.

[skaushik]

Thanks for the responses.

CBC, CRP are normal. Have sent scrapings for KOH prep (rule out candida).

I thought of erythema toxicum but this was present at birth and was itchy, scaly (later).

It certainly does not look like Neonatal pustular melanosis. It is papuloerythematous with no pustules. It also seems to be itchy, with scratch marks on baby's face. Has anyone seen eczema present at birth?

[skaushik]

Baby was seen by Dermatologist. I talked to baby's mother. She said baby is now on hydrocortisone cream and rash is getting better!

[skaushik]

One last post. KOH prep of skin scraping was negative for candida.

[Stefan Johansson]

So, the bottom-line was... some kind of eczema?