Look for Atypical Findings in Red, Scaly Infants.

MONTEREY, CALIF. -- The vast majority of infants with red scaly skin have common inflammatory skin disorders, but other possibilities must be considered when atypical features are present, Dr. Anthony J. Mancini said at a meeting sponsored by the American Academy of Pediatrics.

These might include marked severity of the condition, prolonged course, lack of response to therapy, alopecia, failure to thrive, or associated extracutaneous organ involvement.

While this advice is straightforward, it can be difficult to follow The red scaly baby--defined as an infant with erythroderma covering more than 90% of the skin's surface--can be a diagnostic and treatment challenge, said Dr. Mancini of the departments of pediatrics and dermatology at Northwestern University and Children's Memorial Hospital in Chicago.

The underlying malady is often misdiagnosed and mistreated; the average delay in diagnosis is 11 months. These delays increase morbidity and can often lead to death.

Congenital syphilis is a potentially overlooked, albeit rare, cause of red scaly babies. "Most physicians don't think about it because [congenital syphilis] rates have dropped, but it's still out there."

Congenital syphilis is typically characterized by diffuse papulosquamous eruptions with diffuse scaling and erythroderma, especially on the palms and soles of the feet. Blisters may also be present.

These lesions are "very infectious, and you must use gloves when examining the patient," Dr. Mancini said.