A rash that’s more than skin deep

Discussion Neonatal lupus erythematosus is an acquired disease of the newborn caused by transplacental transfer of maternal anti-Ro/SSA, anti-La/SSB, and anti-U1 RNP antibodies, and has a frequency of 1 in 12500 to 20000 live births. 2 4 The condition might involve (in order of decreasing frequency) the dermatological, cardiac, hepatobiliary, and haematological systems. 2 4 5 6 Cutaneous manifestation is the commonest feature of neonatal lupus erythematosus and can present at birth 5 or within the first 4-6 weeks of life. 7 8 In one study, skin lesions were characterised as erythematous patches (91.7%), lesions resembling subacute cutaneous lupus erythematosus (50%), petechiae (41.7%), persistent cutis marmorata (16.7%), and discoid lesions (8.3%). First and second degree heart block can resolve spontaneously in the first few months of life. 3 Cutaneous lesions are managed with emollients and mild to potent topical corticosteroids if symptoms are severe. Parents should be advised on sun avoidance or the application of sunscreen. 4 The highest incidence of abnormal laboratory results occur when the infant is 3 months old, and most cases resolve by 9 months. 9 These infants should be reviewed over a longer period to observe for future development of rheumatological diseases. 5 8 9 Approximately half of mothers of babies with neonatal lupus erythematosus are asymptomatic at the time of delivery. 3 10 Of these, nearly half of asymptomatic mothers subsequently develop connective tissue disease. [...]they should be screened for auto-antibodies and reviewed for signs and symptoms.