Neonatal pustulosis (Impetigo Neonatorum), also known as neonatal pemphigus (Pemphigus Neonatorum), is an acute infectious purulent skin disease characterized by large blisters that occurs in newborns, with a rapid onset and high infectivity.

bubble_chart Etiology

It is caused by contact with pestilence from coagulase-positive, phage group II type 71 Staphylococcus aureus. Due to the delicate skin and weak resistance of infants, as well as their first exposure to bacteria, they are particularly sensitive. Additionally, the use of plastic wraps, excessive sweating in hot weather, and increased local skin temperature and humidity make the skin prone to maceration, creating favorable conditions for pyogenic bacteria to invade and multiply. Neonatal impetigo often originates from pestilence carried by maternity staff, midwives, or mothers, some of whom may be carriers. Once this disease is detected in the nursery or breastfeeding room, strict disinfection and isolation measures must be implemented.

bubble_chart Pathological Changes

Histopathology: The pathological changes resemble impetigo, with pustules located beneath the stratum corneum (or beneath the granular layer) and inflammatory cell infiltration in the superficial dermis, where neutrophils are visible.

bubble_chart Clinical Manifestations

It begins as red spots the size of a pinhead to a bean, on which blisters quickly appear. The blisters rapidly enlarge, ranging from pea-sized to walnut-sized or even larger, surrounded by an inflammatory red halo, with thin and easily ruptured blister membranes. Within one or two days, the fluid inside the large blisters turns cloudy, or yellow pus may first appear at the base of the blister, though most of the large blisters will eventually fill with pus. Initially, the blisters are very tense but later expand and become flaccid. After the blister membrane ruptures, a moist, smooth erosion is exposed, which later forms a thin crust. New blisters may appear elsewhere, leading to widespread erosions resembling typical pemphigus. Lesions mostly occur on exposed areas such as the face and hands but can also spread extensively to the trunk and limbs, while the palms and metatarsus often remain unaffected. Occasionally, lesions may appear on mucous membranes or involve the fingers, causing suppurative onychia or paronychia. In the early stages, systemic symptoms are not obvious, but as the condition progresses, fever, diarrhea, pneumonia, nephritis, meningitis, or even sepsis may occur, potentially leading to the death of the child.

1. Pay attention to the cleanliness and hygiene of the newborn's skin. If a sick child is found, they should be isolated immediately, and the infant room, the child's clothing, etc., should be disinfected.

2. Apply high-dose antibiotics with high bacterial sensitivity as early as possible, such as penicillin, new penicillin, erythromycin, cephalosporin, etc.

3. Under sterile conditions, puncture the blister wall, aspirate the blister fluid, and apply a wet compress with 1:10,000 potassium permanganate or 0.1% Rivanol solution. Topically apply 2% Chinese Gentian Violet solution or 0.5–1% neomycin emulsion.

bubble_chart Differentiation

The diagnosis of neonatal impetigo can be made based on the characteristic large pustules followed by systemic symptoms, but it should be differentiated from the following diseases:

1. Staphylococcal scalded skin syndrome: This may be a severe form of the disease. It has an acute onset with severe systemic symptoms, and the skin lesions are mainly large blisters with positive Nikolsky's sign and significant exfoliation, without large pustule lesions.

2. Hereditary epidermolysis bullosa: Blisters mostly occur on trauma-prone and friction-prone areas such as hands and feet, with clear blister contents, and there is often a family history.