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“A Clinico Epidemiological Study on Dermatoses in Preterm Neonates”

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“A Clinico Epidemiological Study on Dermatoses in Preterm Neonates” “A CLINICO EPIDEMIOLOGICAL STUDY ON DERMATOSES IN PRETERM NEONATES” Dissertation submitted in partial fulfilment of the Requirements for the degree of M.D.(DERMATOLOGY, VENEREOLOGY & LEPROSY) BRANCH XX DEPARTMENT OF DERMATOLOGY MADRAS MEDICAL COLLEGE CHENNAI-600 003 THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY CHENNAI MAY 2019 CERTIFICATE This is to certify that the dissertation titled “A CLINICO EPIDEMIOLOGICAL STUDY ON DERMATOSES IN PRETERM NEONATES” is a bonafide work done by Dr. VINITHA KUMARI. G, Post graduate student of the Department of Dermatology, Venereology and Leprosy, Madras Medical College, Chennai – 3, during the academic year 2016 – 2019. This work has not previously formed the basis for the award of any degree. Prof Dr. R. PRIYAVATHANI ANNIE Dr. MOHAMED SAJJID, MALATHY MD (PEAD), DM (NEONATOLOGY), M.D., D.D., D.N.B., M.N.A.M.S., Assistant professor of neonatology, Professor, Institute of Obstetrics & Gynaecology, Department of Dermatology, Women & Children Hospital, Egmore, Madras Medical College & Madras Medical College, Chennai - 3. Rajiv Gandhi Govt. General Hospital, Chennai-600 003. Prof. Dr. U. R. DHANALAKSHMI Prof. Dr. R. JAYANTHI, MD.,DD.,DNB., MD., FRCP (Glasg). Professor and Head, Dean, Department of Dermatology, Madras Medical College & Madras Medical College & Rajiv Gandhi Govt General Hospital, Rajiv Gandhi Govt. General Hospital, Chennai-600 003. Chennai-600 003. DECLARATION The dissertation entitled “A CLINICO EPIDEMIOLOGICAL STUDY ON DERMATOSES IN PRETERM NEONATES” is a bonafide work done by Dr. VINITHA KUMARI. G, Department of Dermatology, Venereology and Leprosy, Madras Medical College, Chennai – 3, during the academic year 2016-2019 under the guidance of Prof. Dr. R. PRIYAVATHANI ANNIE MALATHY, M.D., D.D., D.N.B., M.N.A.M.S., Professor, Department of Dermatology, Madras Medical College, Chennai -3. This dissertation is submitted to The Tamil Nadu Dr. M.G.R. Medical University, Chennai towards partial fulfilment of the rules and regulations for the award of M.D Degree in Dermatology, Venereology and Leprosy (BRANCH – XX) Prof Dr. R. PRIYAVATHANI ANNIE MALATHY, M.D., D.D., D.N.B., M.N.A.M.S., Professor, Department of Dermatology, Madras Medical College & Rajiv Gandhi Govt. General Hospital, Chennai-600 003. DECLARATION The dissertation entitled “A CLINICO EPIDEMIOLOGICAL STUDY ON DERMATOSES IN PRETERM NEONATES” is a bonafide work done by Dr. VINITHA KUMARI. G, Department of Dermatology, Venereology and Leprosy, Madras Medical College, Chennai – 3, during the academic year 2016-2019 under the guidance of Dr. MOHAMED SAJJID, MD (PEAD), DM (NEONATOLOGY), Assistant professor of Neonatology, Institute of Obstetrics & Gynaecology, Women & Children Hospital, Egmore, Madras Medical College, Chennai -3. This dissertation is submitted to The Tamil Nadu Dr. M.G.R. Medical University, Chennai towards partial fulfilment of the rules and regulations for the award of M.D Degree in Dermatology, Venereology and Leprosy (BRANCH – XX) Dr. MOHAMED SAJJID, MD (PEAD), DM (NEONATOLOGY), Assistant professor of Neonatology, Institute of Obstetrics & Gynaecology, Women & Children Hospital, Egmore, Madras Medical College, Chennai - 3. DECLARATION I, Dr. VINITHA KUMARI. G, solemnly declare that this dissertation titled “A CLINICO EPIDEMIOLOGICAL STUDY ON DERMATOSES IN PRETERM NEONATES ” is a bonafide work done by me at Madras Medical College during 2016 - 2019 under the guidance and supervision of Prof. Dr. R. PRIYAVATHANI ANNIE MALATHY, M.D., D.D., D.N.B., M.N.A.M.S., Professor, Department of Dermatology, Madras Medical College, Chennai-600003. This dissertation is submitted to The Tamil Nadu Dr. M.G.R. Medical University, Chennai towards partial fulfilment of the rules and regulations for the award of M.D Degree in Dermatology, Venereology and Leprosy (BRANCH – XX). PLACE: DATE: (Dr. VINITHA KUMARI. G) SPECIAL ACKNOWLEDGEMENT My sincere thanks to Prof. Dr. R. JAYANTHI, MD., FRCP (Glasg), Dean, Madras Medical College, Chennai-3 for allowing me to do this dissertation and utilize the Institutional facilities. ACKNOWLEDGEMENT I am gratefully indebted to Professor and Head of the Department of Dermatology, Prof. Dr. U.R. DHANALAKSHMI, M.D., D.D., DNB., for her invaluable advice, guidance and encouragement. She has been a source of constant motivation and support throughout the study. I am extremely grateful to her for guiding me throughout the study. I would like to express my sincere and heartfelt gratitude to Prof. Dr. S KALAIVANI M.D., D.V., Director and Professor, Institute of Venereology, for her kindness and support throughout the study. I thank Prof. DR. ARASAR SEERALAR, MBBS., DCH., M.D (Paed)., Professor of Paediatrics, Head of the Department – Neonatology Unit, Institute of Obstetrics & Gynaecology, Women & Children Hospital for his guidance, support and encouragement in completing my study. I am grateful and thankful to my guide Prof. Dr. R. PRIYAVATHANI M.D., D.D., DNB., MNAMS., Professor of Dermatology for her guidance, support and encouragement in completing my study. I also thank Dr. MOHAMED SAJJID, MD (PEAD), DM (NEONATOLOGY), Assistant professor of neonatology, Institute of Obstetrics & Gynaecology, Women & Children Hospital for his kindness, guidance, support and encouragement in completing my study. I thank my Professor and Head of the department of Occupational and Contact Dermatitis, Prof. Dr. S. NIRMALA M.D., for her help and support. I thank Prof. Dr. A. RAMESH, M.D., D.D., DNB (DVL) Professor of Dermatology for his priceless support. I express my sincere gratitude to Prof. Dr. V. SAMPATH M.D., Professor of Dermatology for his guidance and support. I thank Prof. Dr. AFTAB JAMEELA WAHAB M.D., D.D., Associate Professor of Dermatology for her advice and encouragement. I wish to thank Prof. Dr. S.KUMARAVEL M.D., D.D., and Prof. Dr. J. MANJULA M.D., DNB., former Associate Professor, Dermatology for theirs support and motivation. I humbly thank my Co-Guide, DR. S.VENKATESAN MD., DNB., Assistant Professor of Dermatology for his valuable guidance throughout my work. I would like to express my sincere and heartfelt gratitude for the time which he has devoted for my research project. I extend my gratitude to Dr. R. MADHU M. D., D.C.H., Dr. V.N.S. AHAMED SHARIFF M.D.D.V.L., B, VIJAYALAKSHMI MD (DVL),. Dr. R,MANIPRIYA MD, DCh., Dr. K. DEEPA MD (DVL) , Dr. C.L. CHITHRA MD (DVL), Dr. S. TAMILSELVI MDDVL, Assistant professors, Department of Dermatology for their kind support and encouragement. I express my thanks Dr. SAMUEL JEYARAJ DANIEL M.D., Dr. K. UMA MAHESHWARI M.D.D.V.L., my former assistant professors, Department of Dermatology, for their support and help. I also thank my STD Associate Professor Dr. VIJAYABHASKAR, M.D.D.V.L my Assistant Professors Dr. P. PRABAHAR, M.D.D.V.L., Dr. H. DHANASELVI, M.D.D.V.L., Dr. K. GAYATHRI, M.D.D.V.L., Dr. T.VASANTHI M.D.D.V.L., Dr. E. BALASUBRAMANIAN, M.D.D.V.L., Dr. R. SNEKAVALLI M.D.D.V.L., Dr. T. VANATHY M.D.D.V.L., and Dr. C. DURGAVATHI M.D.D.V.L., DD., Institute of Venereology for their able guidance. I express my thanks Dr. C. VIDHYA, M.D.D.V.L., Dr. R. HEMAMALINI, M.D.D.V.L., my former assistant professors, Institute of Venereology, for their support and help. I am thankful to my colleagues for their support throughout the study. I am also grateful to all paramedical staffs for rendering timely help to complete my study. I am also extremely thankful to my family for their motivation and encouragement. Last but not the least I am profoundly grateful to all patients for their cooperation and participation in this study. They have been the principal source of knowledge which I have gained during the course of my clinical research. CONTENTS Sl. PAGE TITLE No NO. 1 INTRODUCTION 1 2 REVIEW OF LITERATURE 4 3 AIM & OBJECTIVES 49 4 MATERIALS AND METHODS 50 5 OBSERVATIONS & RESULTS 53 6 CLINICAL IMAGES 76 7 DISCUSSION 84 8 SUMMARY 91 9 CONCLUSION 93 10 BIBLIOGRAPHY 11 ANNEXURES ABBREVIATIONS MASTER CHART KEY FOR MASTER CHART PROFORMA INFORMATION SHEET CONSENT FORM ETHICS COMMITTEE APPROVAL CERTIFICATE PLAGIARISM DIGITAL CERTIFICATE Introduction INTRODUCTION The skin is a complex and dynamic organ which performs numerous vital functions. The maturation process, starts at birth with the adaptation of skin to the relatively dry environment compared to in utero milieu. This adaptive flexibility results in the distinctive properties of infant skin. To deliver proper care to infant skin, it is necessary to appreciate that it is evolving with unique characteristics1. Maturation of skin starts during embryogenesis through intercellular and intracellular signals among different tissue layers. Barrier function development increases with gestational age and the epidermal maturation is complete by 34 weeks of intrauterine life2. During the skin barrier development, impaired function makes the skin susceptible to chemical damage, microbial infections and skin diseases, probably compromising the general health of the newborn. Preterm newborn, during the 1st weeks of life, has an even less developed skin barrier and therefore is even more at risk. Thus, it is exceedingly important to evaluate the risk of infections, topical agent absorption, skin barrier disruption and the risk of thermoregulatory failure. 1 Thus the skin of the preterm especially with low birth weight neonates is very delicate, immature, has weaker dermoepidermal attachment which place them at higher risk of systemic dissemination from cutaneous infections. Most of the conditions develop more rapidly than in adults and are self- limiting. Although a host of the dermatoses in neonates is a result of physiological phenomenon and transitory, its recognition and distinction from life threatening conditions is necessary to allay parent’s anxiety and counsel them regarding its harmless nature. Some of the dermatoses or its variation in clinical presentation may be an earliest marker of certain life threatening conditions eg: X- linked hypohydrotic ectodermal dysplasia present initially in the neonatal period with scaling of skin.
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