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TABLE Differential Dx of desquamating lesions in neonates (2,3,7-13) Condition Characteristics Congenital cutaneous Generalized eruption of erythematous macules, candidiasis papules, and/or pustules with widespread desquamating and/or erosive dermatitis Congenital syphilis Red or pink maculopapular rash (more commonly on the soles), followed by desquamation Neonatal HSV Clustering vesicles on an erythematous base that infection subsequently ulcerate SSSS Macular erythema followed by diffuse epidermal exfoliation Toxic epidermal Fever, diffuse erythema, extensive epidermal necrolysis involvement of any part of the skin HSV, herpes simplex virus; SSSS, staphylococcal scalded skin syndrome.
Two days later, she developed fever, fatigue, and retro-orbital headache, as well as flushing macular erythema over the chest.
Two days later, the patches were removed and the skin evaluated for macular erythema consistent with a type 4 hypersensitivity reaction.