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| CASE IMAGES |
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| Year : 2023 | Volume
: 3
| Issue : 1 | Page : 54-55 |
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Congenital suckling blisters in a neonate: Nothing to worry about
Thirunavukkarasu Arun Babu1, Vijayan Sharmila2
1 Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
2 Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
| Date of Submission | 06-Dec-2022 |
| Date of Decision | 03-Jan-2023 |
| Date of Acceptance | 21-Jan-2023 |
| Date of Web Publication | 27-Feb-2023 |
Correspondence Address:
Dr. Thirunavukkarasu Arun Babu
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri - 522 503, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ipcares.ipcares_279_22
How to cite this article:
Babu TA, Sharmila V. Congenital suckling blisters in a neonate: Nothing to worry about. Indian Pediatr Case Rep 2023;3:54-5 |
A term, baby boy was born by vaginal delivery to a primigravida mother without any risk factors for sepsis. The baby cried immediately at birth and weighed 3.2 kg. Bullous skin lesions were noted on both wrists and hands at birth. The pregnancy had been uneventful without any significant maternal febrile illness. Antenatal ultrasounds were normal. Maternal serological investigations for congenital infections were negative. The family history was not contributory. On examination, the baby was pink and alert. Vital and anthropometric parameters were normal. Three well-demarcated flaccid bullous lesions, round to oval in shape, and approximately 1 cm in diameter [Figure 1] were noted on the dorsum of both hands. On rupture, they formed discrete erosions [Figure 2]. No other skin or mucosal lesions were noted. Spontaneous movement and neonatal reflexes were appropriate. The baby was observed to initially vigorously suck both hands, which ceased once breastfeeding was established. No abnormalities were identified on the systemic examination. | Figure 1: Lesions on the dorsum of the left hand showing one flaccid bullae and another discrete erosion of approximately 1 cm in diameter
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 | Figure 2: Lesion on the dorsum of the right hand showing oval erosion approximately 1 cm in diameter with surrounding desquamation
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We kept the first diagnosis as congenital suckling blisters (CSBs) based on historical absence of a septic setting, the typical anatomical distribution and morphology of lesions, and presence at birth in a well infant without any systemic involvement. The family was reassured. Investigations were undertaken to exclude the close differential diagnoses such as neonatal herpes simplex, varicella, bullous impetigo, and other congenital bullous diseases.[1] The neonatal sepsis screen and C-reactive protein were normal. Gram stain and Tzank smear from the lesions were negative. Blood culture was sterile. The lesions healed within a week without scarring or development of new bullae.
CSBs are benign, self-limiting skin lesions caused by excessive and vigorous sucking of easily accessible parts of the body by the fetus. It represents a normal physiological reflex that appears by the 15th week of gestation and can be appreciated on ultrasonogram. The incidence is 0.42%.[2] Present at birth, the lesions are single or multiple noninflammatory vesicles or bullae-containing sterile fluid that appear as erosions post rupture. They are unilateral or symmetrical bilateral and measure 0.5–2 cm diametrically. The characteristic locations are the dorsal or radial aspect of the wrists, hands, or fingers, and rarely, the toes, feet, or lips (sucking pads).[3],[4] The newborn may continue sucking the affected areas and the lesions usually resolve without any treatment within few days.[3],[4] The diagnosis is clinical and made by exclusion of other bullous lesions.[4] Since CSBs are extremely uncommon, it can lead to misdiagnosis and cause unnecessary anxiety to parents and treating physicians. Awareness of this self-limiting, benign condition can avoid unnecessary diagnostic or therapeutic interventions.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parent(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patient's parents understand that their his names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Monteagudo B, Labandeira J, León-Muiños E, et al. Neonatal sucking blisters: Prevalence and differential diagnosis. An Pediatr (Barc) 2011;74:62-4.  |
| 2. | Darmstadt GL, Sidbury R. Diseases of the neonate. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Pediatrics. 17 th ed. Philadelphia: WB Saunders Co; 2004. p. 2162-4. |
| 3. | Ferahbas A, Utas S, Akcakus M, et al. Prevalence of cutaneous findings in hospitalized neonates: A prospective observational study. Pediatr Dermatol 2009;26:139-42. |
| 4. | Libow LF, Reinmann JG. Symmetrical erosions in a neonate: A case of neonatal sucking blisters. Cutis 1998;62:16-7. |
[Figure 1], [Figure 2]
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