Approach to the neonate with ecchymoses and crusts

Premature and systemically ill infants have a high risk of developing dermatologic infectious complications, displaying the consequences of skin barrier immaturity. Opportunistic infections are an increasing concern in neonates, with cutaneous fungal infections (Aspergillus, Rhizopus, Mucor, Fusarium) observed more commonly as pathogens. Neonates are especially susceptible due to stresses of the perinatal transition to ex-utero life, stratum corneum immaturity, and medical intervention during early life including intravenous catheters, non-sterile adhesive dressings, broad spectrum antibiotic use, and systemic corticosteroids for lung disease. Cutaneous presentations of these infections encompass a broad set of morphologies: papules, vesicles, pustules, ecchymoses, and necrotic, pupuric plaques. There are many etiologies that present as ecchymoses and scaly or crusted lesions. The presentation, diagnosis, and treatment options in the neonatal patient presenting with ecchymoses and crusts will be discussed.