Fig. 25.1
Periorbital and inguinal distribution pattern of skin lesions of neonatal SCLE in a 2-month-old female baby (left). Single efflorescences appear as annular erythematous and scaly plaques (right). The sternal scar results from the implantation of a cardiac pacemaker for atrioventricular block grade III. (Reprinted from Heimann, S., M. Hertl, et al. (2009). “Scaling erythemas in an infant.” J Dtsch Dermatol Ges 7(12):1087–1089. With permission from John Wiley & Sons, Inc.)
A positive history of connective tissue disease of the mother or positive serology for anti-Ro antibodies in the mother and child is supportive of the diagnosis [3, 4].
In unclear cases, a skin biopsy may be performed. Children with cutaneous involvement only have an excellent prognosis. The most life-threatening manifestation is a grade III atrioventricular block, which is not transient and may require pacemaker placement. Other manifestations are lymphopenia, thrombocytopenia, and a disturbance of liver function with elevated liver enzymes and hyperbilirubinemia.
Differential Diagnosis
Erythema toxicum neonatorum is a common benign rash with papules or pustules on erythematous skin of unknown origin.
Childhood seborrheic eczema is an inflammatory scaly dermatitis primarily of the scalp, face, and neck believed to involve an exaggerated cutaneous immune response to the yeast Malassezia furfur.
Childhood psoriasis rarely manifests within the first year of life with erythemato-squamous lesions that may resemble neonatal LE.
In principle, drug eruptions can mimic clinical manifestation of neonatal LE, for example, those occurring after treatment with antibiotics or antiepileptics.
Transient neonatal pustular melanosis is a rare congenital dermatosis with collarette scaling and hyperpigmentation usually associated with formation of vesicles and pustules.
Early congenital syphilis is caused by vertical transmission of syphilis in 50–80 % of exposed neonates and is associated with characteristic skin changes including a bullous eruption or macular rash that typically involves the palms and soles.
NOMID/CINCA – Neonatal-onset multisystem inflammatory disease or chronic infantile neurologic cutaneous articular syndrome – skin symptoms are usually urticaria-like without a predominant epidermal component.Related posts:
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