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LETTER TO EDITOR
Year : 2022  |  Volume : 23  |  Issue : 2  |  Page : 185-186

A neworn with a skin lesion and wrist drop


1 Department of Dermatology, Armed Forces Hospital, Khamis Mushayt, Saudi Arabia
2 Department of Medicine, College of Medicine, Najran University, Najran, Saudi Arabia

Date of Submission10-Dec-2021
Date of Acceptance18-Jan-2022
Date of Web Publication30-Mar-2022

Correspondence Address:
Dr. Muhammed Haneefa Vadakkumpadam
Department of Dermatology, Armed Forces Hospitals, Southern Region, Khamis Mushayt 62413
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.ijpd_174_21

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How to cite this article:
Vadakkumpadam MH, Alshahrani M, Abualiat AS, Aziz T, Alshahrani A. A neworn with a skin lesion and wrist drop. Indian J Paediatr Dermatol 2022;23:185-6

How to cite this URL:
Vadakkumpadam MH, Alshahrani M, Abualiat AS, Aziz T, Alshahrani A. A neworn with a skin lesion and wrist drop. Indian J Paediatr Dermatol [serial online] 2022 [cited 2022 May 17];23:185-6. Available from: https://www.ijpd.in/text.asp?2022/23/2/185/341467



Madam,

A term newborn with birth weight 2.8 kg, born to a multiparous woman by normal vaginal delivery, presented with wrist drop and discoloration of the skin over the right upper limb. The right wrist was in a fixed-flexed position with an absent spontaneous extension of the wrist and digit. Elbow and shoulder movements were normal [Figure 1]. The skin examination showed an area of ill-defined erythema with erosion in the center surrounded by hyperpigmentation over the right cubital fossa. Hair structures were intact in the lesion and at the periphery [Figure 2]. The baby was otherwise normal. An X-ray study showed no fracture of the humerus or clavicle and no calcifications of the skin or subcutaneous tissue. No other skin lesions were detected elsewhere in the body. A clinical possibility of pressure-induced skin injury with isolated radial nerve palsy was considered. The family was reassured, and topical antibiotics were advised for the erosion. Follow-up at 6 weeks revealed complete healing with minimal scarring and hypopigmentation. Wrist drop improved by 75%.
Figure 1: Right wrist drop with normal flexion at the elbow

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Figure 2: An ill-defined erythema with central erosion and surrounding hyperpigmentation over the right cubital fossa

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Isolated radial nerve palsy is a rare condition reported in the newborn, resulting in wrist drop with loss of extension of the wrist and fingers. However, the shoulder and elbow movements are preserved.[1] Literature search shows that about 77% of newborns have associated skin lesions on the affected upper limb, whereas 22% of newborns without skin lesions.[1],[2],[3] Various lesional morphologies have been described ranging from a subcutaneous nodule, induration, erythema, ecchymosis, bruising, hematoma, dimpling, or constriction band.[1],[2],[3],[4],[5] The firm subcutaneous nodule is the most common skin lesion associated with isolated radial nerve palsy and is clinically thought to be an area of fat necrosis.[1],[3] Many authors believe that skin lesions are sequelae of prolonged intrauterine compression of the skin and subcutaneous tissue leading to radial nerve injury during its course along the arm, but unclear whether the compression occurs during late pregnancy, delivery, or both.[4] Our case had erythema with surface erosion and peripheral hyperpigmentation, which we believe that skin injury might have happened during late pregnancy, causing postinflammatory hyperpigmentation.

Regarding the site of occurrence of skin lesion, the most common site, in general, is the arm, especially the posterolateral or lateral aspect of the lower arm, where the radial nerve is more vulnerable to injury.[1],[2],[3],[4],[5] In our case, the lesion was located in the cubital fossa, which has not been reported before. The radial nerve anatomically passes through the lateral boundary of the cubital fossa; hence, compression in this area could have resulted in skin lesions and nerve damage. Isolated radial nerve palsy of the newborn usually has an excellent outcome, with complete, spontaneous recovery described within 6 months of life in most patients.[2],[4] Therefore, once the diagnosis is established, parents can be reassured of its excellent prognosis. Neonatologists and dermatologists need to be aware of this condition, and a detailed skin examination is helpful to make a confident diagnosis.

Declaration of consent

The authors certify that they have obtained all appropriate consent forms, duly signed by the parent(s) of the patient. In the form the parent(s) has/have given his/her/their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child 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 Top

1.
Alsubhi FS, Althunyan AM, Curtis CG, Clarke HM. Radial nerve palsy in the newborn: A case series. CMAJ 2011;183:1367-70.  Back to cited text no. 1
    
2.
Carsi MB, Clarke AM, Clarke NP. Transient neonatal radial nerve palsy. A case series and review of the literature. J Hand Ther 2015;28:212-5.  Back to cited text no. 2
    
3.
Siqueira MG, Scaramuzzi V, Heise CO, Martins RS, Sterman H. Bilateral radial nerve compression neuropathy in the newborn. Childs Nerv Syst 2014;30:1435-9.  Back to cited text no. 3
    
4.
Monica JT, Waters PM, Bae DS. Radial nerve palsy in the newborn: A report of four cases and literature review. J Pediatr Orthop 2008;28:460-2.  Back to cited text no. 4
    
5.
Carrato V, Troisi A, Berti I, Travan L, Starc M, Risso FM. A newborn with a wrist drop and a skin marking. J Pediatr 2020;216:237-237.e1.  Back to cited text no. 5
    


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