Explaining a neonatal pustular eruption and giving a safety-net — OSCE

Communication and structured-discussion OSCE on a two-day-old term neonate with scattered pustules on an erythematous base across the trunk, sparing the palms and soles, in an otherwise well baby. The candidate must explain the likely diagnosis of erythema toxicum, why no tests or treatment are needed, the natural history, and a clear safety-net, while demonstrating the recognition of the dangerous blistering presentations (neonatal herpes simplex, staphylococcal scalded skin syndrome) that would demand escalation.

osce communication diagnosis safety-net3 min readVerification in progress

Prompt

A two-day-old term neonate on the postnatal ward has scattered pale-yellow pustules on an erythematous base across the trunk and proximal limbs. The baby is feeding well, is afebrile, pink and warm, and behaves normally; the palms and soles are spared. The parents are anxious that the baby has an infection. The candidate must explain the likely diagnosis, why no tests or treatment are needed, the expected course, and a clear safety-net, while showing they can recognise the features that would demand escalation.

Candidate instructions (8-minute station)

You are the paediatric registrar on the postnatal ward. A midwife has asked you to review a two-day-old term neonate who has developed scattered pale-yellow pustules on an erythematous base across the trunk and proximal limbs over the last few hours. The baby is feeding well, is afebrile, pink and warm, and behaves normally. The palms and soles are spared. The parents are very anxious that the baby has a serious infection and have asked to speak with a doctor. ^[2]

Your tasks are: ^[1]

Take a brief, focused history and confirm the wellness of the baby.
Explain the likely diagnosis and why no tests or treatment are needed.
Give a clear, specific safety-net.
Show the examiner you can recognise the features that would demand escalation. ^[1]

You have eight minutes. The examiner may ask you to explain your reasoning. ^[1]

References5Show

[1]Wilson JL; Nanni SD Neonatal Dermatology. Prim Care, 2025.PMID 40835282
[2]Schwartz RA; Janninger CK Erythema toxicum neonatorum. Cutis, 1996.PMID 8864602
[3]Ramamurthy RS; Reveri M; Esterly NB; et al Transient neonatal pustular melanosis. J Pediatr, 1976.PMID 1271148
[6]Pinninti SG; Kimberlin DW Neonatal herpes simplex virus infections. Semin Perinatol, 2018.PMID 29544668
[10]Leung AKC; Barankin B; Leong KF Staphylococcal-scalded skin syndrome: evaluation, diagnosis, and management. World J Pediatr, 2018.PMID 29508362

Explaining a neonatal pustular eruption and giving a safety-net — OSCE

osce communication diagnosis safety-net3 min readVerification in progress

Candidate instructions (8-minute station)

Your tasks are: ^[1]

Take a brief, focused history and confirm the wellness of the baby.

Explain the likely diagnosis and why no tests or treatment are needed.

Give a clear, specific safety-net.

Show the examiner you can recognise the features that would demand escalation. ^[1]

You have eight minutes. The examiner may ask you to explain your reasoning. ^[1]

References5Show

[1]Wilson JL; Nanni SD Neonatal Dermatology. Prim Care, 2025.PMID 40835282
[2]Schwartz RA; Janninger CK Erythema toxicum neonatorum. Cutis, 1996.PMID 8864602
[3]Ramamurthy RS; Reveri M; Esterly NB; et al Transient neonatal pustular melanosis. J Pediatr, 1976.PMID 1271148
[6]Pinninti SG; Kimberlin DW Neonatal herpes simplex virus infections. Semin Perinatol, 2018.PMID 29544668
[10]Leung AKC; Barankin B; Leong KF Staphylococcal-scalded skin syndrome: evaluation, diagnosis, and management. World J Pediatr, 2018.PMID 29508362