title: Cutaneous manifestations of systemic viral diseases in neonates: an update.
abstract: OBJECTIVE
  Dermatologic findings may be the first signs of a neonatal viral infection. This review provides an update of the diagnostic features and therapies for selected viral illnesses [herpes simplex virus (HSV), varicella zoster virus, enterovirus, and Zika virus] that present with cutaneous manifestations in the neonate.
  
  
  RESULTS
  HSV DNA polymerase chain reaction of plasma and cerebrospinal fluid, routinely used in the diagnosis of neonatal HSV, may have expanded utility in assessing prognosis and acyclovir therapeutic efficacy. Maternal antiviral suppressive therapy may alter the clinical appearance of congenital HSV, resulting in delayed diagnosis and treatment. VariZIG, a varicella zoster immune globulin, is a US Food and Drug Administration approved form of prophylaxis for varicella. The Centers for Disease Control and Prevention has expanded the period of VariZIG eligibility for preterm infants, a group particularly susceptible to severe varicella infection. For severe neonatal enterovirus sepsis, the results of a randomized, double-blind, placebo-controlled trial of pleconaril, a viral capsid inhibitor, suggest that this compound is an effective therapy. Human Parechovirus type 3, a strain within a newly formed viral genus, has a similar, and potentially underestimated, clinical presentation to enterovirus sepsis. However, a distinctive erythematous palmoplantar rash may be specific to human Parechovirus type 3 infection. Perinatal Zika virus infection in the neonate may present with a nonspecific macular and papular rash. As this rash is not specific, obtaining a maternal travel history and, if appropriate, requesting additional diagnostic testing are critical for early diagnosis.
  
  
  CONCLUSIONS
  Neonatal rashes may be harmless and transient, whereas others may reflect the presence of a severe systemic illness. Recognizing key cutaneous features of viral-associated rashes may aid in the prompt and accurate diagnosis and treatment of neonatal viral illnesses.
authors.affiliation: aGeisel School of Medicine at Dartmouth, Hanover, NH bSection of Dermatology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH cUniversity of Connecticut, Farmington, CT and Seacoast Dermatology, Portsmouth, NH, USA.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Castillo
authors.forename: Anh Khoa
authors.initials: AK
authors.lastname: Pham
authors.forename: James G
authors.initials: JG
authors.lastname: Dinulos
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000032:analysis; D004769:Enterovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment; D017193:Skin Diseases, Viral / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D000073618:Varicella Zoster Virus Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D000071243:Zika Virus Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral