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Objective. Emollient cream moisturizers are often used on premature newborns in neonatal intensive care units without accurate knowledge of the risks or benefits to the neonate. Design. We prospectively compared premature neonates treated with a water-in-oil emollient cream for up to 16 days to untreated premature neonates. Setting. The study was completed in a neonatal intensive care unit on neonates admitted for respiratory distress and/or possible sepsis. Patients. Thirty-four neonates, between 29 and 36 weeks estimated gestational age, entered the study. Interventions. One-half of the neonates were treated twice a day with an water-in-oil emollient cream, and the other half served as controls. Outcome Measures. The skin condition of the neonates' hands, feet, and abdomen was evaluated on entering the study and twice a week. Fungal cultures and quantitative bacterial cultures were obtained from the axilla and abdomen on entering the study and twice a week. Results. The mean gestational age of the treated neonates was 32.3 weeks, whereas the mean gestational age of the control neonates was 32.5 weeks. The neonates treated with emollient cream demonstrated statistically less dermatitis of their hands (day 2 through day 11), their feet (day 2 through day 16), and their abdomen (day 7 through day 11). Fungal cultures and quantitative bacterial cultures of the abdomen and axilla were equivalent in both groups. Conclusions. These studies document that emollient cream moisturizer therapy of premature neonates decreases dermatitis without changing the microbiological flora.

Within the first days of life, 10 infants, of 32 weeks' gestational age or less, began 2 weeks of treatment with a semipermeable wound dressing over a small area of skin. The effects of the dressing on transepidermal water loss and cutaneous microflora were evaluated. Transepidermal water loss from the semipermeable dressing-treated skin was significantly less than that from the untreated skin immediately after placement of the dressing (8.1 ± 1.8 g/m2 · h-1 vs 17.7 ± 3.5 g/m2 · h-1, P < .0001). The normal accelerated skin maturation process that occurs in these infants continued beneath the semipermeable dressing. The number of gram-negative bacilli or other bacteria did not increase beneath the semipermeable dressing beyond that seen on the untreated site. Malassezia furfur was found only on the control site, never beneath the semipermeable dressing. According to results of this preliminary study, a semipermeable dressing can be safely used in premature infants and the use of a semipermeable dressing may decrease the excessive transepidermal water loss associated with prematurity.

Although an association between herpes simplex virus (HSV) infection and erythema multiforme (EM) minor has been documented in adults, this has not been reported in the pediatric population. This study assessed the potential role of HSV infection in the pathogenesis of EM minor in children. Erythema multiforme skin lesions from 20 children, aged 1 to 16 years, were examined for the presence of HSV by using the polymerase chain reaction. The children included all fit strict clinical criteria for EM minor. Ten had a clinical history of an antecedent herpes infection ("herpes-associated EM"), and 10 did not ("idiopathic EM"). Herpes simplex virus DNA was detected in skin lesions of 8 of 10 children with herpes-associated EM and in 8 of 10 with idiopathic EM. Control skin biopsies from children with other bullous inflammatory diseases were negative. In addition, no HSV could be detected in a biopsy of normal uninvolved skin of a child in whom HSV was present in lesional skin. In situ hybridization on selected biopsies by means of an HSV-specific riboprobe confirmed the presence of HSV and localized it to the epidermis. It is concluded that HSV is a significant precipitating factor for EM minor in children, as it is in adults, and that clinicians should maintain a high index of suspicion of HSV even in the absence of a known history of herpes infection.

Diaper dermatitis may result from prolonged skin contact with wetness and bacteria. Ammonia plays no apparent role in the generation of diaper dermatitis. Candida albicans frequently contaminates a diaper dermatitis and should be considered present in any diaper dermatitis known to be present for longer than three days. Topical fluorinated glucocorticosteroids, boric acid, and mercury-containing preparations should be avoided in the diaper area because of their toxicity.

Two cases of twin transfusion syndrome are described in which the donor twin exhibited blueberry muffin-like macules and papules associated with ctuaneous erythropoiesis. No evidence was found in either case for intrauterine viral infection, the most common cause of cutaneous erythropoiesis. Cutaneous erythropoiesis is these two cases is considered to be due to persistence or reactivation of fetal dermal erythropoiesis secondary to prolonged, severe intrauterine anemia.

Major textbooks of pediatrics1-7 and dermatology8-11 as well as special editions on pediatric dermatology12 suggest that molluscum contagiosum requires treatment in infants and children. Pricking the surface of the lesion and expressing the contents is the most frequently recommended therapy1,4-7,9,11 but curettage is also frequently suggested.2-4,6,7,10 Podophyllin, Cantharone, trichloroacetic acid, benzoyl peroxide gels, phenol, glacial acetic acid, liquid nitrogen cryotherapy, surgical excision, oral tetracycline, and thiosemicarbazol are suggested in one or another of these references as alternative measures.