Erythematous papules in a preterm infant

Introduction: A skin rash in a pre-term baby may just be a heat rash!

A preterm neonate developed a skin rash while on prolonged kangaroo care during the third week of admission. This female infant was born by normal vaginal delivery at 34 weeks and weighed 1.4 kg (< third centile; small for dates) and was fed by breast milk. Her initial stay in neonatal intensive care was uneventful, as she had consistent weight gain. She was therefore followed up on the ward, where a practice of prolonged kangaroo care was encouraged. On the fourth day there, she developed a pyrexia of 37.8 °C. A polymorphic rash was noted with widespread maculopapular eruption over the neck, chest and upper abdomen, and a few vesicles over the chest containing clear fluid, with erythematous macules also found on the back and acral parts (Fig. 1 and Supplemental Figures).

Figure 1.

Illustrates polymorphic rashes in the preterm infant, including erythematous macules, papules and occasional vesicles in a preterm infant. Erythema is inconsistently present around the papular eruptions.

The papules were small, grain-sized. Such eruptions in excessively warm environs are typical of miliaria rubra or heat rash with a concomitant presence of miliaria crystallina. ¹ The lesions resolved promptly and spontaneously.

A punch biopsy showed epidermal vesicles in communication with eccrine ducts and epidermal inflammatory changes, thus excluding erythema toxicum, a common dermatological eruption in neonates. Other differential diagnoses considered to be considered are cutaneous candida, varicella zoster, neonatal acne, folliculitis or febrile eruptions; however, these differ in appearance and course. Miliaria rubra is a clinical diagnosis, and no further work-up is required; a biopsy is not usually required if there are no ominous signs of infection or other underlying illness.^2,3

Prolonged kangaroo care in a preterm infant rarely results in hyperthermia. However, the additional warmth of tropical heat in the summer months might have led to excessive warmth in the infant. The visual appearance of the rashes may be alarming to an inexperienced paediatrician.

Supplemental Material

sj-docx-1-tdo-10.1177_00494755231201194 - Supplemental material for Erythematous papules in a preterm infant

Supplemental material, sj-docx-1-tdo-10.1177_00494755231201194 for Erythematous papules in a preterm infant by Chetan Khare and Deepika Rustogi in Tropical Doctor