FIGURE 69.5 Infant with candidal diaper dermatitis FIGURE 69.6 Acropustulosis of infancy FIGURE 69.7 Clusters of vesicles and erosions on the cheek of a child with HSV Since neonatal herpes infection can be seen up until weeks of age, clinicians caring for newborns in clinics, offices, and emergency department must be familiar with the clinical manifestations of this disease process Once there is suspicion of neonatal HSV, obtain the following samples before starting antiviral therapy: CSF for indices and HSV DNA PCR, Swab for viral culture +/− PCR from base of vesicles, Swab from the mouth, conjunctiva, nasopharynx and rectum for viral culture +/– PCR, and Whole blood for HSV DNA PCR Start empiric intravenous acyclovir therapy (60 mg/kg/day divided in doses) For SEM disease, treat for 14 days For disseminated and CNS diseases, treat for 21 days and then treat with oral acyclovir suppressive therapy for months (900 mg/m2/day divided in doses) Also, for both CNS and disseminated diseases, repeat CSF analysis and CSF HSV PCR before stopping therapy and, if detectable in CSF, continue therapy until negative CSF PCR results Dose of acyclovir should be weight-adjusted for the duration of therapy Absolute neutrophil count should be monitored every weeks for the first month and then monthly Incontinentia Pigmenti Incontinentia pigmenti (IP) is a rare X-linked genodermatosis that primarily affects female neonates (see Chapter 67 Rash: Vesiculobullous ) The first manifestation occurs in the early neonatal period and progresses through four stages: vesicular, verruciform, hyperpigmented, and hypopigmented Clinical features also manifest themselves through changes in the teeth, eyes, hair, CNS, bone structures, skeletal musculature, and immune system IP is often mistaken for an infectious process ( Fig 69.8 ) PCR and cultures of the vesicles yield negative results The clue to this diagnosis is that the vesicles usually occur on the arms and/or legs in a linear pattern that follows the lines of Blaschko Genetic testing and/or a biopsy can help confirm the diagnosis Rarely, boys that are XXY or have somatic mosaicism present with IP FIGURE 69.8 Linear vesicles in a newborn with the first stage of incontinentia pigmenti ... infection can be seen up until weeks of age, clinicians caring for newborns in clinics, offices, and emergency department must be familiar with the clinical manifestations of this disease process Once