common neonatal skin problems
TRANSCRIPT
Presented by
Surg Lt Cdr Manas R Mishra
COMMON NEONATALCOMMON NEONATALSKIN PROBLEMSSKIN PROBLEMS
Diaper Rash
‘Nappy rash’, ‘ammoniacal dermatitis’Irritant dermatitisExposure to
urine & stools
Diaper Rash
Skin creases sparedExclude superimposed Candidal infection
Diaper Rash
RxFrequent diaper changesExposure of region to allow dryingZinc oxide creams; even prophylactically
Candida albicans Rash
Moist, warm areasFrequently intertriginous areas
Neck folds, axillaediaper area
Confluent,erythematousplaques with sharplydemarcated edges
Candida albicans Rash
Satellite lesions (pustules on contiguous areas of skin)
Skin folds involved
RxMiconazole cream,
powder
Staphylococcus aureus
Staphylococcal pustulosis
Bullous Impetigo
Staphylococcal Scalded Skin Syndrome
Staphylococcal Pustulosis
Usually at 3-5dys old
Discrete pustules witherythematous base
Staphylococcal Pustulosis
Diaper area, periumbilical, neck, lateral aspect of chest
RxSystemic
Cloxacillin
Bullous Impetigo
Flaccid blisters, rupture quickly, become superficial round/oval erosions
RxSystemic Cloxacillin,
Cephalosporin
Seborrhoeic Dermatitis
Onset within 1st 2mths
Greasy yellow scaleson an erythematousbase, minimalpruritus
Seborrhoeic DermatitisFace, eyebrows, scalp (cradle cap)
Seborrhoeic DermatitisDiaper area, flexural areas (posterior auricular sulcus, neck,
axillae, inguinal folds)
Seborrhoeic Dermatitis
Localised or generalisedIf severe, fissures may develop & become
secondarilyinfected
CausePityrosporum ovale
(yeast)
Seborrhoeic Dermatitis
Spontaneously improves by end of1st yr
RxCradle cap shampooOlive oil on scalp to soften crusts (for 1hr before washing off)1% Hydrocortisone cream sparingly
Atopic Dermatitis
Atopic dermatitis& seborrhoeicdermatitis shareclinical features
Atopic Dermatitis
Difficult to distinguishduring neonatalperiod
Atopic Dermatitis
Differentiating featuresPruritic (cardinal feature)
Irritable, scratching & rubbing against nearby objectsDiaper area sparedRecurrence after clearingDry, white scalingStrong family history of atopy
Atopic Dermatitis
RxEmollients liberally particularly immediately after bath0.5% or 1% Hydrocortisone cream sparinglyTreat superimposed infections
Erythema Toxicum
50-70% of term babies; rare in preterm
Basic lesion is a small(1-3mm) papule,evolves into pustulewith a prominenthalo of erythema
Erythema Toxicum
Few to numerous, small areas of red skin with yellow-white centre
Usually on trunk, frequently on extremities& face
Palms & solesalmost alwaysspared
Erythema Toxicum
Most noticeable at48hrs; may appearas late as 7-10dys
Smear: EosinophilsBenign, resolves
spontaneously
Salmon Patch
Naevus simplex or macular haemangioma30-40% infantsDistended dermal
capillariesFlat, pink macular lesion
Salmon Patch
ForeheadUpper eyelidNasolabial area
Most resolve by 1 yr
� Crying makes fadinglesion more prominent
Salmon PatchGlabella (‘angel’s kiss’)Nape of neck (‘stork bite’) Most resolve by 1 yr
Usually persists
Port-wine Stain
Nevus flammeus0.3% neonates, seen at birthMost commonly on
faceAlso trunk, back,
limbsOften unilateral
Port-wine Stain
At birth, pink & macularWith time, darken to reddish purple (especially face),
papulonodular surface (on limbs greater tendency to fade)
Port-wine Stain
Vascular malformation of dilated capillary-like vesselsDo not involuteMajority are isolated
Port-wine Stain
Exclude Sturge-Weber syndrome, Klipple-Trenaunay syndrome
RxPulse-laser therapy
Strawberry Haemangioma
Bright red, raised, well circumscribed
Strawberry Haemangioma
At birth, may beabsent or pale maculewith irregular margins
Strawberry Haemangioma
Grow rapidly during 1st 6mths; continue to grow till 1yrMore common in head, neck & trunk; in premature
infants
Strawberry Haemangioma
Majority involute with by age 4-5yrs(50% by 5 yrs)
Strawberry Haemangioma
ComplicationsObstruction: Eye, ear, airway
Strawberry Haemangioma
ComplicationsUlceration
Strawberry Haemangioma
ComplicationsBleeding
Associated visceral involvementLiver, GIT, lungs, CNS
Naevus Sebaceum
Single yellowishslightly raisedhairless plaque
Scalp or face
Naevus Sebaceum
Excessive sebaceous glands & malformedhair follicles
Naevus Sebaceum
Risk of benign or malignant tumours in 15% (rarely before puberty)
RxExcision
before puberty
Basal Cell Carcinomadeveloped onNaevus Sebaceum
Basal Cell Carcinomadeveloped onNaevus Sebaceum
Café au lait Spots
Light brown, round or oval, maculesSmooth edgesVary in size
Café au lait Spots
Do not resolve with timeHistology: Increased melanin within basal keratinocytes,
without melanocyteproliferation
Few small spotsof littlesignificance
Café au lait Spots
NeurofibromatosisMcCune-Albright syndromeRussell-Silver syndromeMultiple lentigenesAtaxia telangiectasiaFanconi anaemia
Tuberous sclerosisBloom syndromeEpidermal naevus syndromeGaucher diseaseCh diak-Higashi syndromeē
Disorders with Café au lait Spots
Café au lait Spots - NeurofibromatosisCafé au lait Spots - Neurofibromatosis
Mongolian Spots
90% blacks, 80% asians, 10% whitesBrown, grey, blue maculesCommonly
lumbosacral area;occasionally upperback, limbs, face
Vary in size &number
Mongolian Spots
Infiltration of melanocytes deepin dermis
Often fade within 1st fewyrs due to decreasingtransparency of skinrather than truedisappearance
Sucking Blisters
Clear blisterLip, finger, hand, wristFriction of
repeated sucking
Sucking BlistersSome may be healed & appear like callusesResolves spontaneously
Sucking PadSucking Pad
CephalhaematomaCephalhaematoma
CephalhaematomaCephalhaematoma� from prolonged stage II of labour� instrumental delivery, especially ventouse� the misshapen head can cause some parental alarm� subperiostial swelling � boundaries is limited by bony margin, doesn't cross midline
Treatment� Reassurance� will resolve with time 4-8 weeks.complications � Anaemia from the quantity of bleed into the haematoma � Jaundice from haemolysis within it. � Calcification
CephalhaematomaCephalhaematoma
Oral CavityOral CavityOral CavityOral Cavity
Oral Thrush
White curd-like plaques on orobuccal mucosa, extends to pharynx if severe
Adherent,difficult toscrape off
Oral Thrush
May affect feeding
RxMiconazole oral gelSyrup Nystatin 100 000U qds
Umbilical CordUmbilical CordUmbilical CordUmbilical Cord
Umbilical Cord
Routine care: Clean with alcohol to base of cord (where it attaches to skin), exposure to air to help dry cord
Umbilical Cord
Usually separates within 1wk after birth (mean 7-14dys)Delayed separation (> 14dys)
Neutrophil function/chemotactic defectsBacterial infection
Umbilical Sepsis
Periumbilical erythema& induration
Purulent discharge
Umbilical Sepsis
Risk of haematogenous spread, extension to liver, portal vein phlebitis & later portal hypertension
RxPrompt parenteral antibacterial therapy
Umbilical Granuloma
CommonGranulation tissue at baseSoft, granular,
dull red or pinkSeropurulent
secretion
Umbilical Granuloma
Differentiate from gastric/intestinal mucosa
RxCauterisation with silver nitrateRepeat at intervals of several dys until base is dry
Umbilical Polyp
RareRemnant of vitelline duct or urachusFirm &
bright red(intestinal orurinary tractmucosa)
Umbilical Polyp
Mucoid secretion, faecal material or urineRx
Surgical excision of entire VI or urachal remnant
SpineSpineSpineSpine
Spinal DysraphismLumbosacral region
Skin dimple/sinus tractHairy patchPigmented naevusHaemangiomaLipoma
Ultrasound spine
JaundiceJaundiceJaundiceJaundice
Neonatal Jaundice
Common CausesPhysiologicHaemolytic
ABO/Rh incompatibilityG6PD deficiency
Breastmilk jaundiceBreastfeeding jaundice
Physiologic JaundiceAppears around D2-3
Peaks around D4-5
Falls after D5-7
Neonatal Jaundice
Management
Adequate fluid intake
PhototherapyCriteria dependent on birthweight, postnatal age & presence of
haemolysis
Neonatal JaundiceSunning
Not recommendedNot effectiveRisk of dehydration & sunburn
Prolonged Neonatal Jaundice
Jaundice beyond
14dys in term baby
21dys in preterm baby
Prolonged Neonatal JaundiceSome Causes
Breastmilk jaundiceHypothyroidismUrinary tract infectionBiliary atresiaNeonatal hepatitis
Prolonged Neonatal Jaundice
Investigations
Liver function testTotal & direct bilirubin
Urine FEME & cultureThyroid function test
Breastfeeding Jaundice‘Breast-nonfeeding’ or ‘starvation jaundice’Early onset, exaggeration of early jaundice with higher SB in
1st 5dysDue to inadequate frequency of breastfeeding & insufficient
caloric intake which enhances bilirubin absorption
Breastmilk Jaundice
Late onsetProlongation of physiologic jaundice, SB continues to rise
from D5Levels stay elevated, then fall slowly, returning to normal by
4-12wksIn 3rd wk, ~ 1/3 full term exclusively breastfed babies will be
clinically jaundiced
Breastmilk Jaundice
Baby is well with good weight gainLFT is normalIf breastfeeding is stopped, SB will fall rapidly in 48hrsIf resumed, SB may rise a little, if at all, but will not reach
previous high level