1. What essential question does one still need to ask to help make the diagnosis?
2. What is the tentative diagnosis?
3. Can you list at least three differential diagnoses?
4. What features of this condition differentiate it from other conditions?
5. What is the suitable treatment of this condition?
When A Newborn Presents With A Skin Condition On Both Feet
A 30-year-old Caucasian female brings her 3-week-old son into the clinic with a skin condition on both feet. The mother reports that the pregnancy was uncomplicated. She says the baby was born full-term with a normal birth weight of 7.2 pounds and no problems noted.
The mother also says she was healthy before and during the pregnancy, and that she is not taking any prescription medications or other drugs. She has been taking regular perinatal vitamins and minerals, including vitamin C and E, as directed by her personal obstetrician. The mother denies smoking, drinking alcohol or caffeinated liquids.
At birth, the child received a clean bill of health. No deformities, irregularities or other problems were noted on the birth examination forms.
However, soon after arriving back at home, the mother noticed several small red flat spots and “bumps” on the infant’s hands, stomach and legs, which all resolved after a few days of regular bathing and using Penaten® Baby Lotion (Johnson and Johnson). At no time was there any obvious rash formation on the face or mouth. She says there was no diaper rash or similar problem involving the genitals, groin or buttocks area.
Shortly thereafter, the mother noticed redness between the baby’s toes, which eventually progressed to very small, fluid filled blisters forming within the area of redness. The mother states that several new small blisters then appeared on the bottom of both feet, followed by some cracking of the skin below the toes and on the balls of the feet. She began cleaning his skin and feet more often and applied Penaten. She said the lotion appeared to clear up the blisters but the condition did not respond completely. Two days prior to the latest visit, she also noticed extensive peeling of the skin around the toes and ball of both feet.
What Did The Exam Reveal?
The physical exam at the first clinic visit revealed pink to erythematous intertriginous moist patches, surrounded by a thin, overhanging fringe of somewhat macerated epidermis. There is a large excoriation on the distal ball of the left foot coming from the first interdigital space. Tiny, superficial white pustules are adjacent to the patches. There is evidence of healed blisters and vesicles on the plantar aspect with increased erythema along the ball of the feet and the plantar surface of all the toes.
There are areas of maceration at the interdigital spaces, fine fissures and cracks of the skin at the plantar creases of most of the toes, and generalized areas of thin desquamation at the distal toes. The hands showed a similar pattern of skin changes but to a much less extensive degree. There are no other skin abnormalities.
What You Should Know About Cutaneous Candidiasis
When a baby develops cutaneous candidiasis this early on, he or she likely picked it up during the birth process. Candida albicans, the most common cause of vaginitis, is more common in women during pregnancy. Reportedly 20 percent of healthy, non-pregnant women have vaginal Candida, and significantly more test positive during pregnancy. Since not all women show symptoms of a vaginal yeast infection, many no doubt are carrying Candida through their births. If the baby picked up Candida during his birth, he may get a cutaneous infection very quickly thereafter. In these cases, the oral cavity and diaper area are usually spared. Involved areas typically include the trunk, palms, soles and may include the cutaneous nail folds.