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Management of Pustules and Vesicles in Afebrile Infants ≤60 Days Evaluated by Dermatology

Sonora Yun1, Colleen Cotton2,3, Esteban Fernandez Faith4,5,6

  • 1Columbia University Vagelos College of Physicians and Surgeons, New York, New York.

Pediatrics
|June 24, 2024
PubMed

Insights

Afebrile infants with skin pustules/vesicles rarely have serious bacterial infections. Herpes simplex virus (HSV) or fungal infections are more likely, especially in preterm infants, warranting targeted testing and cautious antibiotic use.

Area of Science:

  • Neonatal Dermatology
  • Pediatric Infectious Diseases
  • Neonatal Medicine

Background:

  • Neonatal pustules and vesicles can be concerning for serious infections.
  • Afebrile infants with these skin findings require careful evaluation to differentiate benign from severe etiologies.

Purpose of the Study:

  • To evaluate the management and outcomes of afebrile infants presenting with pustules and/or vesicles.
  • To identify the incidence of serious bacterial, viral, and fungal infections in this cohort.

Main Methods:

  • Retrospective review of medical records for infants ≤60 days old with pustules/vesicles across 6 academic institutions.
  • Analysis of infectious workup results, including blood, cerebrospinal fluid, and urine cultures.
  • Identification of specific diagnoses such as herpes simplex virus (HSV) and fungal infections.

Main Results:

  • 183 afebrile infants with pustules/vesicles were identified out of 879 consults.
  • No serious bacterial infections were confirmed; however, 53% received parenteral antibiotics.
  • Herpes simplex virus (HSV) was diagnosed in 7% of infants, and angioinvasive fungal infections in 3% (all extremely preterm).

Conclusions:

  • Serious bacterial infections are unlikely in afebrile, full-term infants with isolated pustules/vesicles after excluding HSV.
  • Preterm infants with pustules/vesicles require a high index of suspicion for serious infections and broad infectious evaluation.
  • HSV testing is recommended for all infants with vesicles, grouped pustules, or punched-out erosions.
Abstract

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