Medicine is both an art and a science, and there is no more critical situation for the two to blend as in the evaluation of the newborn who has a vesiculopustular rash. Does the patient appear healthy or toxic?Life-threatening conditions can look innocuous, whereas self-limited rashes that do not need therapy can become generalized and appear dramatic! More than 30 conditions are included in the differential diagnosis, and there is no place for “shotgun” approaches with their inherent dangers.

Signs and symptoms can be deceiving, or at the very least misleading. Primary lesions(vesicles, bullae, or pustules) often are hidden in a sea of secondary changes (erosions, ulcerations, or crusting). Classic presentations, such as grouped vesicular lesions of a herpes simplex infection, might not be apparent. It is essential to be aware of the diverse range of possibilities to formulate an organized, comprehensive plan of attack.

Infections always should be considered...

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