Sucking blisters are a cutaneous condition on newborns that is present on their extremities at birth. This is not to be confused with sucking pads, which are similar in appearance. Sucking blisters are due to natural neonatal sucking reflexes on the affected areas in utero. These sucking blisters become present at birth when the sucking movements are very aggressive while in the uterus. These blisters are commonly found on the newborn's arms, fingers, or any body part they are able to suck on. It is a very rare condition, seen in less than 1% of newborns. It is difficult to diagnose because its appearance can be mistaken as other skin conditions. Diagnosis is usually done by eliminating other possible cutaneous conditions. This process of elimination includes examining blood culture, lesions, and inflammatory markers. This skin condition is usually self-inflicted, benign and can heal on its own. Sucking blisters do typically not require medical treatment and disappear within a week.
Signs and symptoms A fetus robustly sucking on areas such as forearm, fingers and hands while in utero can cause a blister on those affected areas presenting at birth, with a diameter ranging from 0.5 centimeters to 1.5 centimeters. The blisters commonly happen on one side of the involved area but in some cases, they are on both extremities. However, there is no difference in the severity of the condition with regard to how many extremities the blisters are present on. Continued sucking would cause the blister to rupture so in some cases newborns will present with a denuded skin while others' blisters stay intact at birth. The fluid inside the blister is clear, yellowish and shows negative results on bacterial cultures. Sucking blister is considered a noninfectious condition and is usually not harmful. There are limited resources of this skin condition in any textbook about pediatric patients and skin conditions, which explains the unfamiliarity in practice of pediatricians or dermatologists. Providers must determine the diagnosis of sucking blisters based on the information available on the presentation of other congenital blistering conditions to successfully rule them out. Understanding the causes and manifestations of both simple and complex skin damage and conditions will help providers address the issue and provide care. According to its characteristic as a non-serious and self-limiting condition, providers can avoid any unnecessary diagnostic procedures and treatments for the newborns, if it is sucking blister, which can relieve the anxiety for the parents of newborns. There have also been reports of sucking blisters forming on the lips, which is very uncommon in comparison to the typical locations of blisters on extremities. Treatment for the blisters on this rare location is similar to any other affected area of sucking blister.
Clinical studies and case reports
Case reports on extremities A newborn who was born to a 26-year-old Caucasian women at the 41st week of gestation was seen with 2 round erosions on the left wrist in the postpartum examination. Both mother and baby were healthy with no history of infection and skin abnormalities. The sucking was even observed during the examination of the affected area. There was no treatment prescribed and the lesion was resolved after several days. Another newborn who was born to 34-year-old woman via untraumatic natural delivery at her 39th week of gestation was seen with an erosion on her left forearm via examination happening just after birth. No abnormalities were detected during the pregnancy and the mother was healthy. After one week, her lesion was spontaneously healed without any treatment. Another newborn was detected with a lesion on the left wrist with its diameter of 1.5 centimeters x 1 centimeters. There was no relevant history regarding the mother's or neonate's health condition during gestation to explain the cause of this lesion. Parents of the newborn were frustrated and anxious because their baby got this skin condition right after birth. During examination, the newborn did show sucking of the affected area which helped to ease their parents that the blister happened in the womb. No treatment was given, however, an intervention helped the lesion resolve in six weeks. The intervention involved the use of a dummy for the baby to suck on in between bottle feeds. This was to prevent the baby to suck on their own hand, and allow the wound to stay clean and dry for proper healing.
Rare case report of blister on the lips A newborn, who was born at the 38th week of gestation, was seen with blisters on both lips during a physical examination happening right after birth. The condition was resolved only after 1 day without any medical intervention. Sucking blisters are not to be confused with leukoedema or sucking pads, as these both are often found on the baby's lips, thumb, or arm, and may be due to the sucking mechanism of the baby. Sucking pads are usually found on the border of the lips, specifically towards the inside of the mouth when looking at the line of the lip. Sucking pads, similar to sucking blister, are also caused by the sucking mechanism of the neonate in utero. However, sucking pads can take three to six months to disappear, whereas sucking blisters may resolve itself within a week. Another similarity with sucking blisters and sucking pads are that they both have bullae with fluids inside and are both benign conditions that may not need treatment. Demographic data There was a prospective cohort descriptive study conducted on one thousand newborns born from September 2015 to 2016 in Northeast Thailand to try and identify any types of skin conditions during their first five days post-birth. The most common skin conditions were Mongolian spots, found in 66.7% of the newborns, and sebaceous gland hyperplasia, found in 60.9% of the newborns. The study classified sucking blister in the "miscellaneous cutaneous conditions." Sucking blister was found in 10/1000 newborns which is about 1% of the study population. Other miscellaneous cutaneous conditions in the study were aplasia cutis (0.2%), nevus sebaceous (1.2%), epidermal nevus (0.4%), and bullous impetigo (0.8%).
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