CONGENITAL CANDIDIASIS

•This infection occurs in utero as a result of ascending infection from the genital tract of the mother causing chorioamnionitis.

•Born with a maculopapular rash often presenting within the first 12 hours.

•The lesions develop into vesicles, pustules, or bullae in 1–3 days.

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•Palmar and plantar pustules are regarded as a hallmark of congenital cutaneous candidiasis

•Oral involvement is usually absent.

Treatment :

•Any topical anticandidal agent, e.g. nystatin, clotrimazole, miconazole, or econazole, may be used.

•In case of systemic involvement, systemic antifungal agents, e.g. amphotericin, 5-flucytosine, and fluconazole, may have to be used.

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Congenital candidiasis in a neonate born at 24 weeks’ gestation. Note the “burn-like” erosions and desquamation.

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DISORDERS CAUSED BY TRANSPLACENTAL

TRANSFER/ MATERNAL MILK

•These include pempemphigus vulgaris, pemphigus foliaceus, herpes gestationis and lupus erythematosus.

•Because immunoglobulin A (IgA), IgM and IgE antibodies do not cross the placenta in significant amounts, this phenomenon is restricted to diseases caused by autoantibodies of IgG class.

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NEONATAL PEMPHIGUS VULGARIS

•Neonatal pemphigus vulgaris is caused due to transplacental transmission of anti Dsg antibodies to neonates from to mothers who suffered from pemphigus during pregnancy.

•Affected infants have cutaneous and/or mucosal erosions or bullae.

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•No treatment is required as the lesions have resolved spontaneously within about 3 weeks, and circulating IgG antibodies have become undetectable by the end of the 2nd month of life.

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NEONATAL LUPUS ERYTHEMATOSUS

•Neonatal lupus erythematosus (NLE) is a rare syndrome comprising transient skin lesions resembling subacute cutaneous lupus erythematosus (LE) and/or congenital heart block .

•Associated with the transplacental passage of maternal autoantibodies to the ribonucleoproteins (RNPs) Ro SSA (>90%), La SSB or rarely U 1 RNP.

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•It occurs in neonates up to 3 months old.

•The risk of connective tissue disease later in life is increased.

•Skin lesions - well defined areas of macular erythema, frequently annular, occurring predominantly on the face, particularly the forehead, temples and upper cheeks, and on the scalp and neck .

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•A ‘spectacle like’ distribution of lesions around the eyes is especially characteristic.

•A degree of atrophy and/or telangiectasia are frequent long term sequelae.

•Sunlight may induce skin lesions.

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Pathology

•Skin biopsy demonstrate the features of LE: epidermal atrophy, liquefaction degeneration of basal keratinocytes, colloid bodies and a perivascular and periappendageal lymphohistiocytic inflammatory infiltrate in the dermis.

•DIF(50%) - showing dermal-epidermal junction and perivascular deposition of IgG, IgM and C3.

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