Sucking Blisters

section name header

Basics ⬇

Blisters or erosions seen on the extremities in newborns due to vigorous sucking in utero.

Clinical Manifestations ⬆ ⬇

Presents as a single, oval shaped, superficial vesicle or bullae or as an erosion with a collarette of scale (Fig. 2.9).
Usually seen on the dorsal hands or fingers or forearms but can also be found on the lips.

Diagnosis ⬆

Diagnosis is based on clinical recognition.

Differential Diagnosis

Bullous Impetigo

Superficial flaccid vesicles or bullae that rupture easily. Little to no surrounding redness.
Typically multiple lesions and located in intertriginous areas such as the diaper area and axillae.

Epidermolysis Bullosa

Genetic skin condition that presents with variable amounts of skin blistering and erosions at birth.
New blisters will form easily at sites of trauma or friction.

Neonatal Herpes Infection

Grouped vesicles on an erythematous base may be on any cutaneous surface and involve the mucosa; when ruptured, lesions appear as punched out erosions.
Tzanck smear of vesicle base will show multinucleated giant cells. HSV culture or DFA will be positive for HSV1 or 2.

Management

The most important first step in management is ruling out an infectious etiology or genetic skin condition.
Sucking blisters heal completely without scarring within 2 weeks.
Petrolatum ointment can be applied to lesion twice daily to hasten resolution.