Erythroderma or Blistering in neonates: review from the MSF Telemedicine Platform and management in low-resource settings

INFECTION Staphylococcal

Impetigo

CONGENITAL Ichthyoses

CONGENITAL Epidermolysis bullosa

METABOLIC

Staphylococcal scalded skin syndrome.

Flaccid blistersFever

collodion membrane

blisters following trivial trauma

Zinc deficiency

Periorificial and acral dermatitis

Results• 20 clinical cases were identified among 3400• 12 cases were excluded (> 1 month age)• The median delay in providing the first

specialist response was 4.8 h (IQR 1.8, 8.4).

• Suspected cause of erythroderma included ichthyosis (5), infection (4), epidermolysis bullosa (6), Acrodermatitis enteropathica –zinc deficiency (1) and unknown origin (4).

• Skin biopsies or genetic testing were not possible. That is a major limitation, but the main point is to inform the best approach to handling these cases in a setting where such advanced testing is not possible.

IntroductionErythroderma and blistering are rare life-threatening entities during the first monthof life. At this age, the main underlying cause are limited and include infections, inheritedconditions as ichthyosis or epidermolysisbullosa and less frequently metabolicdisorder and toxic epidermal necrolysis.

AimTo review the use of MSF Telemedicine in managing skin disorders in newborns in low-resource settings.

MethodsWe performed a retrospective analysis of cases referred from April 2010 to June 2016 to the MSF Telemedicine Platform based on the Collegium Telemedicus system.

Managing neonatal erythroderma and blistering in the field.

A request for information was sent 21 days after the initial submission since October 2013. The response rate was 20% (3/15). The responses were largely positive. 100% of referrers found the advice helpful.

Hydratation

Nutrition

Pain management

Psychological support

Meticulous wound care

An infectious origin is mandatory to consider

ConclusionErythroderma and blistering in the neonate require rapid and appropriate treatment to decrease morbidity and mortality.

MSF field doctors seem to appreciate specialist support for this pathology. Clinical protocol should be considered associated to adapted Telemedicine services.

Wound care with little means

Sophie Delaigue1 2, Jaap Karsten3, Daniel Martinez Garcia4, Harriet Roggeveen3, Hanna Faghfoury5, Sabine Sigaudy6, Jules Lipoff7,Dedee Murrell8, Jean Jacques Morand9, Hubert Vuagnat10, Karolyn Wanat11, Marie-Claude Bottineau12, JF Saint-Sauveur4

Médecins Sans Frontières (1. Toronto, 3. Amsterdam, 4. Barcelona, 12. Geneva). 2. Department of Dermatology, Cayenne Hospital, French Guiana. 5. Division of Clinical Genetics, University of Toronto, Canada. 6. Division ofClinical Genetics, Timone Hospital, Marseille, France. 7. Department of Dermatology, University of Pennsylvania, Philadelphia, USA. 8. Department of Dermatology, St George Hospital, Sydney, Australia. 9. Department ofDermatology, Sainte-Anne Hospital, Toulon, France. 10. Department of Rehabilitation and Palliative Care, University Hospitals of Geneva, Switzerland. 11. Department of Dermatology, University of Iowa, USA.

Periorificial and acral dermatitis

Zinc deficiency

enquiry@telemed.msf.orgEthics permission was not required

2116