TATN

A PERMANENT ADDITION TO THE LIST OF TRANSIENT NEONATAL DERMATOSES: TRANSIENT ABDOMINAL TELANGIECTASIA OF THE NEWBORN

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By Warren R. Heymann, MD, FAAD
Oct. 25, 2023
Vol. 5, No. 42

Any parent looking at their newborn child will wonder if the skin lesions they observe are worrisome. During the neonatal period, defined as the first four weeks of life, most cutaneous findings are transient and benign; occasionally, they may be manifestations of serious disease. 

Transient vascular changes include cutis marmorata (CM, a reticulated mottling of the skin observed symmetrically on the trunk and extremities, worsened by cold and resolving with warmth) and the harlequin color change (HCC, occurring when the neonate lies on their side, with erythema on the dependent side and blanching on the contralateral side, lasting for 30 seconds to 20 minutes). CM may last a few months, while HCC resolves in a few weeks. Both disorders are considered physiologic; although HCC has been attributed to hypothalamic immaturity causing sympathetic autonomic dysfunction affecting capillary bed tonus. (1,2)

Benign, transient disorders in the neonatal period include milia, miliaria, transient pigmentary lines, erythema toxicum neonatorum, transient neonatal pustular melanosis, and benign cephalic pustulosis. (Infectious neonatal pustular dermatoses due to Staphylococcus, Candida, Herpes virus, or other microbes must be ruled out, if clinically warranted). (1,3,4)

Other transient dermatoses of the newborn reflect underlying pathology. Transient bullous dermolysis of the newborn (TBDN) is a rare variant of dystrophic epidermolysis bullosa caused by autosomal dominant or recessive mutations in COL7A1. TBDN is characterized by subepidermal blistering at birth or shortly thereafter, followed by rapid improvement with minimal scarring or pigmentation. (5) According to Brazzelli et al. "Transient myeloproliferative disorder (TMD) is a spontaneously resolving clonal myeloid proliferation characterized by circulating megakaryoblasts in the peripheral blood that is restricted to neonates with Down syndrome (DS) or those with trisomy 21 mosaicism. Cutaneous manifestations of TMD are observed in only 5% of affected neonates and present as a diffuse eruption of erythematous, crusted papules, papulovesicles, and pustules, often with prominent and initial facial involvement." TMD resolves spontaneously in most cases, although there is a low potential to develop acute myeloid leukemia. (6)

Image with permission from Dr. Cécile Juzot.

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In a retrospective, observational, multicenter study, Juzot et al reported 20 newborns who developed, at a median age of 7 days, large abdominal patches of radially arranged purplish telangiectasia in a bilateral and symmetrical pattern relative to the midline, creating a "butterfly wing" pattern, labeling this entity "transient abdominal telangiectasia of the newborn" (TATN). Clinical examination was normal in 13 newborns; 6 newborns had abdominal distention, and one newborn had poor weight gain due to inadequate breastfeeding. Dermoscopy confirmed telangiectasis; no biopsies were performed. In 15 of the 20 newborns, the umbilical stump had already detached by the time the lesions appeared. Fourteen newborns underwent abdominal ultrasonography, which was unremarkable for 10 of the children, 2 of whom had infrequent stools. Of the 4 scans showing abnormalities, findings included incidental bilateral ovarian cysts, a pelvic mass (in a newborn with rhabdomyosarcoma), stercoral stasis (in a child with Hirschsprung disease), and poorly visualized mesenteric vessels (in the context of abdominal distention). Most lesions spontaneously resolved within 3 months and did not reoccur for 19 newborns. Although the etiology is unknown, the working hypothesis is that increased intraabdominal pressure affects the cutaneous microcirculation. The authors conclude, "While most cases of TATN regress spontaneously and are benign, their presence should lead the clinician to check the medical history, perform a careful clinical abdominal examination, and where appropriate consider abdominal ultrasound to rule out a pelvic or intraabdominal mass. Larger case studies are required to further characterize this entity. The mechanism leading to the manifestation of TATN still remains to be elucidated."

Point to Remember: Pediatric dermatologists must carefully assess any neonate with dermatologic findings. Many are benign and transient. A new neonatal entity has been described — transient abdominal telangiectasia of the newborn (TANT). TANT is a benign disorder. Ultrasound imaging to rule out intrabdominal pathology is indicated if abdominal distention is observed. 

Our expert's viewpoint

Cecile Juzot, MD
Department of Dermatology, Centre Hospitalier Universitaire de Nantes, France

Since our work was published in 2021, I have been able to see a new case of transient abdominal telangiectasia of the newborn (TATN). It was a girl, born at full term. The pregnancy had been marked by lysis of a twin in the first trimester. We examined her at 3 days of age for a hypochromic macule, sometimes purplish, on the left buttock with a similar lesion on the left lower limb, unnoticed on the day of birth. Dermatological and general examination was otherwise normal. On the 19th day of life, I noticed TATN and a discreetly distended abdomen. The telangiectasias reappeared until about 2 months of age, during episodes of abdominal distention. Abdominal ultrasound was normal. The vascular lesion of the left lower limb seems to be related to a cutis marmorata telangiectatica congenita and further explorations are ongoing. Other cases have been described. Cutrone et al described 4 cases, 3 girls and 1 boy, including a premature one, all in the context of abdominal distension. (8) Bosma et alrecently published the case of a boy. (9)

These new cases seem to confirm that TATN are frequent, probably underestimated, frequently occur in a context of abdominal distension, and rapidly disappear spontaneously.

1. O'Connor NR, McLaughlin MR, Ham P. Newborn skin: Part I. Common rashes. Am Fam Physician. 2008 Jan 1;77(1):47-52. PMID: 18236822.

2. Tsuboi K, Tsuboi N, Nosaka N, Nishimura N, Nakagawa S. Neonatal Harlequin color change associated with Prostaglandin E1 administration. Pediatr Int. 2021 May;63(5):610-611. doi: 10.1111/ped.14581. PMID: 34002472.

3. Terry M, Marlowe Stewart D. Transient Pigmentary Lines of the Newborn in a Postmortem Examination: A Case Report. Am J Forensic Med Pathol. 2019 Jun;40(2):171-174. doi: 10.1097/PAF.0000000000000461. PMID: 30689604.

4. Reginatto FP, Villa DD, Cestari TF. Benign skin disease with pustules in the newborn. An Bras Dermatol. 2016 Apr;91(2):124-34. doi: 10.1590/abd1806-4841.20164285. PMID: 27192509; PMCID: PMC4861557.

5. Shi BJ, Zhu XJ, Liu Y, Hao J, Yan GF, Wang SP, Wang XY, Diao QC. Transient bullous dermolysis of the newborn: a novel de novo mutation in the COL7A1 gene. Int J Dermatol. 2015 Apr;54(4):438-42. doi: 10.1111/ijd.12704. PMID: 25800346.

6. Brazzelli V, Segal A, Bernacca C, Tchich A, Bolcato V, Croci G, Mina T, Zecca M, Zanette S, Stronati M. Neonatal vesiculopustular eruption in Down syndrome and transient myeloproliferative disorder: A case report and review of the literature. Pediatr Dermatol. 2019 Sep;36(5):702-706. doi: 10.1111/pde.13931. Epub 2019 Jul 29. PMID: 31355466.

7. Juzot C, Aubert H, Bessis D, Boccara O, Bourrat E, Chiaverini C, Flamant C, Fournet M, Hubiche T, Labrèze C, Martin L, Piram M, Seta V, Finon A, Maruani A, Barbarot S; "Groupe de Recherche Clinique de Dermatologie Pédiatrique". Transient abdominal telangiectasia of the newborn. Pediatr Dermatol. 2021 Jul;38(4):864-867. doi: 10.1111/pde.14620. Epub 2021 Jun 21. PMID: 34152036.

8. Cutrone M, Van Gysel D. Transient abdominal telangiectasia of the newborn: Four new cases with abdominal distension. Pediatr Dermatol. 2023 May 31. doi: 10.1111/pde.15351. Epub ahead of print. PMID: 37258091. 

9. Bosma AL, Van der Zwaan D. Een pasgeborene met vaattekening op de buik [Abdominal telangiectasias in a newborn]. Ned Tijdschr Geneeskd. 2022 Oct 5;166:D6960. Dutch. PMID: 36300458.

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