viral, exam, children, kids

7/30/2019 viral, exam, children, kids.

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NEWBORN RASHES


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INCREASED PIGMENTATION


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ACROCYANOSIS

Incidence: First 2-4 weeks of life

Clinical features: The hands and feet become

symmetrically blue in color secondary to cold

Significance: Differentiate from central

cyanosis

Course and prognosis: Resolves on warming.Does not occur after one month of age.


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ACCESSORY NIPPLES

Incidence: Present at birth

Clinical features: Appears a line from the

mid-axilla to the inguinal area Significance: Develops without areola,

misdiagnosed as congenital nevi

Course and prognosis: Excised for cosmeticpurpose


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MONGOLION SPOT

Incidence: Universal in non-Caucasian neonates, and

Asian infants. Occasionally in Caucasian infants with

dark hair

Clinical features: bluish pigmentation usually in

lumbosacral regions

Significance: mistaken for bruising

Course and prognosis: becomes less obvious as theinfant grows older


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DECREASED PIGMENTATION


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VITILIGO

Incidence: 1-2% of the population. Autosomaldominant with variable penetration

Clinical features: Occurs at any age. Melanocytes are

absent Significance: Differentiated from Abinism that occurs at

birth.

Course and prognosis: Long periods of quiescence maybe interrupted with periods of extension during severestress. Spontaneous repigmentation is unusual


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ALBINISM

Incidence: 1-7%. Inherited as Autosomal recessive

Clinical features: Generalized hypopigmentation of

the skin, eyes, and hair

Significance: Skin protection from sun

Course and prognosis: The skin becomes wrinkled,

and easily blistered by sunshine. Malignant skin

tumors are common. Life expectancy may be reduced


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TRANSIENT AND BENIGN LESIONS


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MILIA

Incidence: Very common. 40-50% of newborn

infants.

Clinical features: fine white spots seen on the nose

and cheeks. Hypertrophic sebaceous glands

Significance: mistaken for infection

Course and prognosis: disappear spontaneously


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TRANSIENT NEONATAL

PUSTULAR MELANOSIS

Incidence: 4% of newborns. Particularly black maleinfants

Clinical features: Present at birth. 2 to 5 mm

diameter pustules on a non-erythematous base.Wright stain shows eosinophils and neutrophils

Significance: none

Course and prognosis: lesions develop a central

crust, which desquamates to leave a hyperpigmentedmacule with a collarette of fine scales.


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ERYTHEMA TOXICUM

Incidence: Extremely common. Affected in the firstweek of life. Not seen in preterm infants.

Clinical features: Vesicles are filled with eosinophils.

Widespread erythematous maculopapular rash usuallybegins in the first week of life. Individual lesions consistof a white central papule surrounded by erythematousflare.

Significance: Mistaken for infection

Course and prognosis: Disappears spontaneously


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SIMPLE NEVUS

Incidence: Very common seen in 30-50% of infants

Clinical features: Bright pink macular capillary

hemangioma seen on the neck, bridge of nose, upper lip

and eyelids. Simple nevi do not blanch on pressure. Significance: none

Course and prognosis: Disappear spontaneously in the

first year of life. Those on the neck are usually

permanent, but never require treatment.


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STRAWBERRY NEVI

Incidence: Common, particularly in preterm infant

Clinical features: Dilated capillaries. Raised, soft,pitted, bright red hemangiomas with a discrete edge. Not

present at birth. Appear in the first few weeks of life. Significance: Ulceration and infection

Course and prognosis: Increase rapidly during the firstyear of life. Regress slowly over the next years.Eventually disappear leaving a pale depigmented area.

Laser surgery done


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STURGE-WEBER SYNDROME

Incidence: Not common

Clinical features: Sharply demarcated flat capillaryhemangiomata. Present at birth and do not increase insize

Significance: Vascular malformation of the ipsilateralmeninges, cerebral cortex, and eye.

Seizure, mental retardation, hemiplegia, and glaucoma.

Course and prognosis: The majority remains aspermanent discoloration of the skin. Laser surgery.


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CONGENITAL PIGMENTED NEVI

Incidence: Not common

Clinical features: Severe cosmetic deformity

may occur.

Significance: 2-10% lifetime risk of malignant

melanoma.

Course and prognosis: Surgical management

and skin grafting.


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SCALING DISORDERS OF THE SKIN


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EPIDERMOLYSIS BULLOSA

Incidence: Very rare. Autosomal recessive

Clinical features: Bullae present soon after birth andcover large areas of the body. Appear after minor trauma.Blisters appear between the basement membrane of theepidermis and the connective tissue of the dermis.

Significance: mistaken for staphylococcal infection.

Course and prognosis: Good nursing care. Minimalhandling, Antibiotics for secondary infection. High

mortality in neonatal form.


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HARLEQUIN FETUS AND


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HARLEQUIN FETUS AND

COLLODION BABY

Incidence: Very rare

Clinical features: At birth, the infant is encased in ashiny, cellophane like membrane, which will distort thefacial features and extremities. Deep fissures are present

between scale like areas of skin

Significance: fluid and electrolyte imbalance

Course and prognosis: Desquamation of the membrane.Lubrication of the skin with creams. Secondary infection.

Few develop icthyotic skin changes.


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IATROGENIC INJURIES


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INFUSION INJURIES

Incidence: Common

Clinical features: Ischaemic necrosis. Transientcyanosis of the leg is seen after UAC placement.

Cyanosis of the toes. Absence of arterialpulsations

Significance: Infection. NEC. Tissue necrosis.

Course and prognosis: Tissue necrosis lead to

ulceration and later scar formation.


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PERINATAL INFECTIONS


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STAPHYLOCOCCAL INFECTION

Incidence: Uncommon

Clinical features: Small pustules anywhere on the body.

Cellulitis. Toxic epidermal necrolysis (TEN) with

extensive epidermal separation. Significance: Septicemia, meningitis and osteomyelitis.

Course and prognosis: All superficial infection treated

with broad-spectrum antibiotics after appropriate swabs

and cultures.


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CYTOMEGALOVIRUS

Incidence: 1% of the newborns

Clinical features: When the mother is infected she

usually has only a mild flu like symptoms. Purpura,

hepatosplenomegaly. Jaundice periventricularcalcifications and pneumonia.

Significance: Microcephaly, deafness, and epilepsy.

Course and prognosis: 5% develop deafness, and 1%

show serious neurological manifestations


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CANDIDA

Incidence: Superficial infection of the mouth orperineum is extremely common

Clinical features: In the mouth appears as white plaqueswhich cannot be wiped off without causing bleeding.

Perineal infection gives a bright red confluent rash in thegroin area. Typical satellite lesions lying peripheral to theconfluent rash

Significance: Fatal systemic infection occurs in preterminfants

Course and prognosis: Topical Nystatin. Systemicantifungal agents


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NEONATAL HERPES INFECTION

Incidence: Uncommon

Clinical features: A generalized vesicular eruptionoccurs. Systemic disease with involvement of the lungs,liver, gastrointestinal tract and brain.

Significance: encephalitis associated with highmortality. Recurrence for up to 5 years

Course and prognosis: High risk of neurologicalabnormality and mental retardation amongst survivors.

Systemic antiviral therapy may be helpful if started early.Elective cesarean sections if active lesions are present.


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CHICKENPOX

Incidence: Common. The fetus will be immune if themother has had chickenpox. Serious neonatal illness willoccur if mother develops rash within 48 hours of delivery

Clinical features: Develop vesicles. Pneumonia.

Purpura fulminance.

Significance: encephalitis associated with highmortality.

Course and prognosis: Infant may rarely have scars.

Hyperimmune globulin should be administered to theinfant. Acyclovir to reduce the risk of complications.

viral, exam, children, kids

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