Angéla Meszes

Amoxicillin rash in patients with infectious mononucleosis: evidence of true drug sensitization

BackgroundIt hasn’t been clearly understood yet whether sensitization to antibiotics, the virus itself or transient loss of drug tolerance due to the virus, is responsible for the development of maculopapular exanthems following amoxicillin intake in patients with infectious mononucleosis. We aimed to examine whether sensitization to penicillin developed among patients with skin rash following amoxicillin treatment within infectious mononucleosis.MethodsTen patients were investigated for drug sensitization by lymphocyte transformation test and six patients were further tested by prick-, intradermal and patch tests employing the penicillin’s main antigens.ResultsLymphocyte transformation test showed negative results with amoxicillin, while one patient had positive reaction to cefixime. Six patients with suspected sensitization to amoxicillin were then investigated by in vivo tests. Prick tests were negative in all six patients, but the intradermal tests showed positive reactions in four patients.ConclusionsOur data demonstrate that in vitro testing is not sensitive enough in determining drug sensitization to penicillin. In vivo tests should be performed to detect sensitization and indeed with skin tests our results confirmed that sensitization to aminopenicillin may develop within infectious mononucleosis.

Iatrogenic Skin Disorders and Related Factors in Newborn Infants

Recent technological advances and diagnostic and therapeutic innovations have resulted in an impressive improvement in the survival of newborn infants requiring intensive care. Consequently, with the use of modern invasive diagnostic and therapeutic procedures, the incidence of iatrogenic events has also increased. The aim of this study was to assess various iatrogenic complications in neonates requiring intensive care and determine possible contributing factors to the injuries.

Lesions requiring wound management in a central tertiary neonatal intensive care unit

BackgroundMost of the skin disorders that occur in neonatal intensive care units are due in part to the immaturity and vulnerability of the neonatal skin. Various iatrogenic diagnostic and therapeutic procedures are also conducive to iatrogenic damage. This study was to review the neonates admitted to our neonatal intensive care unit who needed wound management, and to assess the most common skin injuries and wounds, and their aetiology.MethodsData were extracted from medical records of neonates who needed wound management in our Neonatal Intensive Care Unit between January 31, 2012 and January 31, 2013. Information about gestational age, sex, birth weight, area of involvement, wound aetiology, and therapy were collected.ResultsAmong the 211 neonates observed, wound management was required in 10 cases of diaper dermatitis, 7 epidermal stripping, 6 extravasation injuries, 5 pressure ulcers, 1 surgical wound and infection, 1 thermal burn, and 5 other lesions.ConclusionsInternational guidelines in neonatal wound care practice are not available, and further research concerns are clearly needed. Dressings and antiseptic agents should be chosen with great care for application to neonates, with particular attention to the prevention of adverse events in this sensitive population. Team work among dermatologists, neonatologists and nurses is crucial for the successful treatment of neonates.

Overview of Dermatologic Disorders of Neonates in a Central Regional Intensive Care Unit in Hungary

The immaturity and vulnerability of the skin and epidermal barrier function and the frequent iatrogenic complications following diagnostic and therapeutic procedures are often associated with skin manifestations in infants in neonatal intensive care units (NICUs). The aim of the current study was to investigate dermatologic disorders in neonates in our NICU. A prospective cohort study was conducted in the NICU at the Department of Pediatrics at the University of Szeged between January 2012 and January 2013. All full‐ and preterm infants hospitalized in the NICU underwent whole‐body skin examinations and all dermatologic disorders and treatment modalities were recorded. Eighty‐nine dermatologic conditions were detected in 64 of the 211 neonates admitted to the NICU. A wide variety of clinical symptoms accompanied these conditions in these preterm and severely ill full‐term infants. A considerable proportion of the disorders that were seen resulted from the immaturity of the skin and various iatrogenic complications. Dermatologic disorders are frequent in neonates requiring intensive care. Prevention, early detection, and optimal treatment of these disorders with modern, standardized skin care management strategies can result in significant improvements in barrier function and in the integrity of the skin, increasing the overall efficacy of neonatal intensive care.

Születési jegyek, újszülöttkori borelváltozások. Az angyalcsóktól az epidermolysis bullosáig

INTRODUCTION At present there are no exact epidemiologic data on the prevalence of neonatal skin disorders and birth marks in Hungary. AIM The aim of the authors was to investigate the prevalence of skin disorders in mature healthy neonates after birth. METHOD The survey was carried out in the Neonatal Care Unit at the Department of Obstetrics and Gynaecology at the University of Szeged between April, 2012 and May, 2013. RESULTS A total of 2289 newborn infants underwent whole-body screening skin examinations. At least one skin manifestation was found in 63% of the neonates. The major groups of skin disorders were transient benign cutaneous lesions, vascular lesions, pigmented lesions, traumatic, iatrogenic, congenital or acquired disorders with skin injuries, developmental abnormalities and benign skin tumours. The most frequent transient cutaneous lesions were erythema toxicum neonatorum, sebaceous hyperplasia and desquamation. The most common vascular lesions were naevus simplex, haemangioma and haemangioma precursor lesion, while the most frequently observed pigmented lesions were congenital melanocytic naevi and Mongolian spot. CONCLUSIONS In the vast majority of cases, special treatment was not necessary, but 5.27% of the neonates required local dermatologic therapy, and in 9.2% of neonates follow up was recommended.

Birth marks and neonatal skin disorders. From angel kiss to epidermolysis bullosa

INTRODUCTION At present there are no exact epidemiologic data on the prevalence of neonatal skin disorders and birth marks in Hungary. AIM The aim of the authors was to investigate the prevalence of skin disorders in mature healthy neonates after birth. METHOD The survey was carried out in the Neonatal Care Unit at the Department of Obstetrics and Gynaecology at the University of Szeged between April, 2012 and May, 2013. RESULTS A total of 2289 newborn infants underwent whole-body screening skin examinations. At least one skin manifestation was found in 63% of the neonates. The major groups of skin disorders were transient benign cutaneous lesions, vascular lesions, pigmented lesions, traumatic, iatrogenic, congenital or acquired disorders with skin injuries, developmental abnormalities and benign skin tumours. The most frequent transient cutaneous lesions were erythema toxicum neonatorum, sebaceous hyperplasia and desquamation. The most common vascular lesions were naevus simplex, haemangioma and haemangioma precursor lesion, while the most frequently observed pigmented lesions were congenital melanocytic naevi and Mongolian spot. CONCLUSIONS In the vast majority of cases, special treatment was not necessary, but 5.27% of the neonates required local dermatologic therapy, and in 9.2% of neonates follow up was recommended.

Cutaneous lesions and disorders in healthy neonates and their relationships with maternal-neonatal factors: a cross-sectional study

BackgroundCutaneous lesions are very common in neonates. Although a number of studies have reported on their incidence, very little is known about the factors that influence them. We set out to investigate a large population of neonates with the aims of achieving an overall picture of neonatal skin manifestations, and examining their relationships with various maternal, neonatal and perinatal factors.MethodsThis study was conducted on neonates born at the Department of Obstetrics and Gynaecology at the University of Szeged between June 2013 and July 2015. A total of 4658 consecutive infants underwent a whole-body skin examination within the first 72 hours of extrauterine life. The official neonatal medical charts were used to collect data on the history of the participating neonates and on maternal factors.Results74.35% of the neonates exhibited at least one skin manifestation. The major diagnosis groups were transient, benign cutaneous lesions; vascular lesions; traumatic, iatrogenic, congenital or acquired disorders with skin injuries; pigmented lesions; and developmental abnormalities or benign skin tumours. The relationships between the skin findings and six neonatal or maternal factors were examined: gender, gestational age and birth weight of the neonates; maternal age and the number of previous pregnancies of the mothers, and mode and circumstances of the delivery.ConclusionsWe found several significant correlations between the examined maternal/neonatal factors and the occurrence of birthmarks and neonatal skin disorders. Of course, further studies are required to confirm and better understand these associations.

What can vasculitic leg ulcers implicate

Dear Editors, A 76-year-old woman presented with multiple irregular necrotic leg ulcers surrounded by palpable purpurae on the right leg, persisting for 2 years (Figure 1). Three years before, her left leg was amputated because of ulceration and concomitant septicemia. The patient had pallor, xerostomy, xerophthalmia, distal limb numbness without parotido-, lymphadenoor hepatomegaly. Haematoxylin–eosin-stained sections of the ulcer showed leucocytoclastic vasculitis with erythrocyte extravasation; direct immunofluorescence showed granular IgG and complement factor 3 depositions. Laboratory tests showed marked hypoproteinaemia, hypoalbuminaemia, elevated erythrocyte sedimentation rate, mild pancytopenia, high carbamide, creatinine, uric acid and C-reactive protein levels. Proteinuria, microscopic haematuria, granular, hyalin and cell cylinders suggested glomerular involvement. Autoimmune serology found positive anti-nuclear antibody, a robust elevation of anti-SS-A and rheumatoid factor and a moderate increase in anti-SS-B levels. Cryoprecipitation showed massive cryoglobulinaemia. Immunofixation electrophoresis detected non-quantifiable IgMκ biclonal and IgMλ monoclonal bands, and serum-free light chain assay showed very high κ level and abnormal κ:λ ratio (Table 1). Review of CT images revealed splenomegaly, but no lytic bone lesions related to multiple myeloma. Ultrasound and CT examinations showed bilateral parenchymal atrophy of the kidneys. Bone marrow trephine biopsy revealed discrete interstitial B-cell population suggestive of indolent B-cell lymphoproliferation, but no evidences of B-cell monoclonality was detected by PCR-based immunoglobulin heavy chain gene rearrangement analysis.

Transient Zebra-like Hyperpigmentation in a Healthy Newborn

The authors present here the case of a healthy neonate born with extensive zebra-like hyperpigmentation along the lines of Blaschko with unique resolution of symptoms [1–5]. The neonate was born after an uneventful pregnancy via cesarean section in the 38th gestational week. Her birth weight was 3220 g and Apgar score was 10/10 at 1′. Short after birth, cutaneous examination revealed asymmetrically distributed, reticular hyperpigmentation composed of 1–3 mm reddish-brown, homogeneous macules forming whorls and streaks along the lines of Blaschko on the back, abdomen, chest, gluteal region, r ight shoulder and arm, and left thigh (Fig. 1a&b). The skin appendages, including hair and nails, were normal. Her family history was negative for any pigmentation disorder. Physical, neurological and ultrasound examination showed an otherwise healthy baby. On the 4th day of life, considerable fading of the streaks was noticed, and the girl became totally symptom-free by the age of 3 wk; no inflammation or papular, vesicular or verrucous eruption was observed. In view of the rapid regression of the skin symptoms, histological examination was not performed. The follow-up at the age of 9 mo did not show any recurrence of the symptoms; the somatic, motoric and mental development of the infant was normal. Linear whorled and naevoid hypermelanosis (LWNHM) is an extremely rare, sporadic pigmentary disorder characterized by hyperpigmented swirls and streaks along the lines of Blaschko. Symptoms usually can be seen at birth or develop in the first 1–2 y of life, often progressing for 1–2 y before stabilization, or become less prominent and show minimal fading with age. The typical, linear and whorled hyperpigmented streaks follow the lines of Blaschko. Pigmentary lesions are not preceded by inflammatory events, vesiculobullous or verrucous stages. Somatic mosaicism leading to the proliferation and

Születési jegyek, újszülöttkori bőrelváltozások.Az angyalcsóktól az epidermolysis bullosáig | Birth marks and neonatal skin disorders. From angel kiss to epidermolysis bullosa

INTRODUCTION At present there are no exact epidemiologic data on the prevalence of neonatal skin disorders and birth marks in Hungary. AIM The aim of the authors was to investigate the prevalence of skin disorders in mature healthy neonates after birth. METHOD The survey was carried out in the Neonatal Care Unit at the Department of Obstetrics and Gynaecology at the University of Szeged between April, 2012 and May, 2013. RESULTS A total of 2289 newborn infants underwent whole-body screening skin examinations. At least one skin manifestation was found in 63% of the neonates. The major groups of skin disorders were transient benign cutaneous lesions, vascular lesions, pigmented lesions, traumatic, iatrogenic, congenital or acquired disorders with skin injuries, developmental abnormalities and benign skin tumours. The most frequent transient cutaneous lesions were erythema toxicum neonatorum, sebaceous hyperplasia and desquamation. The most common vascular lesions were naevus simplex, haemangioma and haemangioma precursor lesion, while the most frequently observed pigmented lesions were congenital melanocytic naevi and Mongolian spot. CONCLUSIONS In the vast majority of cases, special treatment was not necessary, but 5.27% of the neonates required local dermatologic therapy, and in 9.2% of neonates follow up was recommended.