skin findings & skin diseases in newborn
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SKIN FINDINGS & SKIN DISEASES IN THE NEWBORNDr. Ahmed A. SaadDHMAR GENERAL HOSPITALREBUPLIC OF YEMENStructural and functional differences of adult and term infantnewbornAdult50 m50 mEpidermal thicknessnormalnormalCell attachements (desmosmes, hemidesmosomes) low Collagen and elastic fibers normaldermisFewerDelayed activity for 17 daysnormalmelanosomes low Neurologic control for 23 yearsnormalNormal
low Terminal hairnormalhairI -PHYSIOLOGIC SKIN FINDING IN THE NEWBORNVERNIX CASEOSA
whitish-gray covering on newborn skin andis composed of degenerated fetal epidermis and sebaceous secretions..Seen in all infants
Cutis marmorata-Reticulated, vascular mottling on the leg of a healthy newborn which resolves quickly with warming.-Physiologic response to cold with resultant dilatation of capillaries and small venules.-Cutis marmorata that persists beyond the neonatal period may be a marker for trisomy 18, Down syndrome.
Neonatal hairlossNeonatal hair at birth is actively growing in the anagen phase , but within the first few days of life converts to telogen hair. Consequently, there is normally significant hair shedding during the first 3 to 4 months of life.II-BIRTHMARKSCOMMON BIRTHMARKS
1) Mongolian spot2) Hemangioma3) Port-wine stain4) Salmon patch/Angel kiss/Stork bite/nevus flammeus nuchae4)caf au lait macules5)Congenital nevi
III-TRANSIENT ERUPTIONS OF THE NEWBORNErythema Toxicum NeonatorumClinical: papules and pustules that start within 48 hours of birth lasting 2-3 days; affects theface/trunk/proximal extremities; spares the palms/soles.Most common pustular rash(up to70%of full-term.Usually fade over 5-7 days.
Sucking BlisterA blister or denuded area seen in neonates, secondary to sucking the area of the blister in utero; generally seen on the hand/wrist/forearm
Transient Neonatal Pustular Melanosis#Occurs in 4% of infants, more common in dark skinned infants#Typically present at birth#2-5mm pustules with hyperpigmented, non-erythematous base#Over time develops central crust & leaves hyperpigmented macules with collarette of white scale#Cause unknown#Benign & self-limited#Pustular lesions resolve within 24-48 hours, hyperpigmented macules fade over weeks/months
Miliaria/Heat Rash/Prickly Heat1-3mm erythematous papules (miliaria rubra), pustules (miliaria pustulosa) or crystal-clear vesicles resembling water droplets (miliaria crystallina)Appear on face, scalp and trunk,Due to obstruction of eccrine sweat ducts with leakage of sweat into dermis/epidermisOccur secondary to heat (eg. warm climates) in skin areas with high heat generation or covered by clothingCommon, particularly in infants and children because of underdeveloped sweat glandsSelf-resolving, can be hastened by removal of wraps/clothing
MiliaCommon (50% of infants)Multiple 1-3mm, white-yellow papules on nose, chin & cheeks.Keratin filled epithelial cysts.Usually appear in 1st month of life & may persist several months, but may occur at any age.Benign, self-resolving, require no treatment.Can be excised and contents expressed.
Neonatal acneOpen & closed comedones (papules/pustules), on face and upper trunk.Thought to be due to androgens (maternal & infant).Common (20% of infants).Often present at birth or develops in second to third week of life.Self-resolving, usually by three months age, require no treatment.
IV-CUTANEOUS INFECTIONS Neonatal H.semplex Majority of cases acquired during delivery . Clinical spectrum ranges from localized skin lesions to multi-systemic infection with encephalitis,hepatitis, pneumonia, and coagulopathy. Use of scalp electrodes increase risk of neonatal transmission in HSV-infected mothers. In utero infections can rarely occur and are associated with fetal anomalies microcephaly, encephalitis,and intracranial calcificatons.
VaricellaVaricella in Pregnancy First 20 weeks of gestation: Congenital Varicella Syndrome - hypoplastic limbs, ocular and CNS abnormalities. 5 days before and 2 days after delivery: Neonatal Varicella - neonate develops varicella at 5 to 10 days ofage .V-RASHES IN THE DIAPER AREA
Diaper dermatitis generally refers to the irritant contact dermatitis.Result from multiple factors:macerated skin , rubbing and wiping, and ammonia (urine) and proteases and lipases( stool).Diaper dermatitisErosivenapkin dermatitis. Notesparing in the flexures.
PSORIASIS --------Dark-red plaques, may have a silvery scale. Nails May have pinpoint pits CANDIDAL INFECTION--------Erythema with fragile satellite pustules. Pinpoint satellite vesicopustulesoften present . folds often affected.OTHER CONDITIONS-------- Acrodermatitis enteropatheca,Grauloma gluteale infantum ,seborrhoec dermatits ,histicytosis,impetigo..
VI-MATERNAL SKIN DISEASES &NEW BORNVaricella-zoster virus (VZV)
Congenital varicella: -------- 020 weeks 1-2% scaring, limb hypoplasia , multisystem involvement . 13-40weeks-------shingles in infancy 1-2% -7-+7days---------neonatal varicella Rubella0-8 weeks--------spontaneous abortion(20%)0-16 weeks------congenital rubella syndrome (85%): sensoneural deafness, heart defect, retinopathy , cataract, microphthalmia , psychomotor retardation.
Blueberry Muffin Baby Dermal extramedullary erythropoiesis. Generalized distribution of 1 to 7 mm purpuric papules, especially on head, neck, and trunkCauses: torch, parvovirus b-19,hemolytic anemia and another .
Systemic lupus erythematosusNeonatal lupus syndrome:#5% typical geographic & annular scaly erythematous lesions on the face ,scalp and sun exposed area(disappears within 6months)#2-3% heart block(20% dying in early childhood and most require a pacemaker.
Pemphigoid gestationis510% of infants born to mothers with PGhave cutaneous lesions1. Transient urticarial orvesicular lesions are most common and resolvespontaneously within around 3 weeksSyphilis# intrautrine infection in early pregnancy may result in stillbirth or miscarriage. #congenital $ usually caused by infection after 1-st trimester(placenta completely formed) #no evidence of transmission via human milk, without breast lesions.#70-100%of infant born to untreated mothers are infected-----congenital syphilis.Congenital syphilisStart with secondary $ without primary $.The most common finding in the skin is a papulosquamous eruption on the palms soles and spreading over the extremities , face and trunk.Other manifestations : radial scaring around the mouth ,rhinitis ,
VII-HEREDITARY DISEASESEPIDERMOLYSIS BULLOSA-Rare inherited mechanobullous skin disorders that are characterized by skin fragility and bullae formation.-Many vareants.-Blisters forms in area of friction.-In some types blistering occurs during infancy.
Localized flaccid bullae on the foot of an infant
Colloidon baby-Baby encased in parchement-like membrane which may impair respiration and sucking .-Shed 2-3 weeks later-------risk of infections--- need hopitalization & incubation.-60-70%develop some form of ichthyosis.-20% go to have totally normal skin.
Harlequin fetusRare sever form of congenital ichthyosis.Prognosis very poor.