DIAGNOSIS AND TREATMENT OF PUSTULAR DISORDERS IN THE NEONATE

The diagnosis of a pustular dermatosis occurring during the first mont hs of life is usually based on clinical findings, However, some cases may require simple investigations including microscopic examination of pustular content, cultures, and skin biopsies, The main benign transi ent neonatal types of pustulosis include erythema toxicum neonatorum, infantile acropustulosis, transient neonatal pustular melanosis, and n eonatal acne, The most common causes of infectious pustular skin lesio ns include bacterial infections, which may be initially localized (Sta phylococcus aureus) or septicemic (with Listeria monocytogenes as the leading causitive agent); viral infections (herpes simplex, varicella- zoster, and cytomegalovirus infections); fungal infections (candidiasi s); or parasitic disorders (scabies), The main objective of this artic le is to propose a systematic approach to pustular eruptions in the ne onate, The need for investigating every neonate with pustules for an i nfectious disease is emphasized, The Tzanck smear, the Gram's stain, a nd a potassium hydroxide preparation are the most important quick diag nostic tests, The Tzanck smear is a very easy, rapid, and sensitive te st for detection of a herpetic infection (multinucleated giant cells) as well as noninfectious pustular eruptions (eosinophils, neutrophils) , Therefore the Tzanck smear should be the first test performed, Moreo ver, a Gram's stain and potassium hydroxide preparation should be perf ormed in cases of neonatal pustular disorders to detect bacterial and fungal infections, The goal of this diagnostic approach is to spare a healthy neonate with a benign transient condition an invasive evaluati on for sepsis, potentially harmful antibiotic therapy, and prolonged h ospitalization, with its own inherent morbidity.