Common Neonatal Dermatoses

Common Neonatal Dermatoses

Introduction

 As a pediatrician one of the most common presenting complaints is that of an infant with a rash and with the large number of possible diagnoses (on the order of more than 30!)
 It is essential to be able to recognize the characteristic appearance of common lesions.
 Furthermore, it is imperative to be able to identify life-threatening disease processes from benign, self-limiting disease.

 
Transient skin findings in the neonate

Colour changes
Skin redness
Jaundice
Vascular tone
Harlequin colour changes
Cutis marmorata (6.7% **)
• Genital hyperpigmentation (5% Caucasians; 20% Mongolians)
• Desquamation (65%; 14.6% *)
• Sebaceous gland hyperplasia (48%; 31.8% †)
• Acne (1.2% ‡)
• Epstein pearls (56%; 88.7% †), Bohn pearls
• Milia (48%; 34.9% †; 19% *)
• Adnexal polyp of neonatal skin around nipple (4.1% §)
• Toxic erythema (35%; 40.8% §; 20.6% †; 15.7% *)
• Transient pustular melanosis (1.7% ‡)
• Miliaria crystallina (3.1%; 4% §; 14.6% †; 16.9% *)
• Miliaria rubra (4% §; 5.5% *)
• Sucking blisters (9.8%)
• Perianal dermatitis (18.9% §; 7% *)


Neonatal desquamation

 Postmaturity in the neonate, and sometimes dysmaturity

 Dif Dx:
 Collodion baby syndrome

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Harlequin colour changes
Harlequin colour change (HCC) is defined as transient erythema involving one - half of the infant ’ s body with simultaneous blanching of the other side and a sharp demarcation on the midline.

In some cases, HCC may be associated with tonic attacks and bradycardia, triggered by various factors, including defecation, rectal pain, perineal stimulation or emotion.

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Aetiology.
 Since original reports concerned mostly premature/low - weight babies or infants with intracranial injury, it was long thought that the abnormality in the central nervous control of the vascular tone was located at the hypothalamic level.

 Indeed, most affected infants are in good general health with no other signs of dysregulation of vital functions.

Premature infants are more commonly affected than full - term infants.
 Harlequin colour change usually occurs on the third or fourth day of life, though it has been noted up until the 21st day of life.
 The midline demarcation of the erythema and the transitory colour changes (30 s to
 20 min) are diagnostic
 The face and genitalia are usually spared. The tongue and lips are unaffected.
 Accentuation occurs following gravitational changes.
 Turning the infant on the other side may induce blanchingof the red side and reddening of the pale side


Cutis marmurata

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Transient neonatal hyperpigmentation

 The genital area, and particularly the scrotum in male infants, and the dorsal surfaces of the distal phalanges of both hands and feet are the most frequently involved

 Less frequently, nipple and areola, helix, umbilicus, and sometimes large skin folds

 During the 1st yr

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Neonatal papulopustular eruptions

Infections
• Bacterial pustules: bullous impetigo, systemic sepsis (listerosis)
• Congenital cutaneous candidiasis
• Herpes, varicella, cytomegalovirus infection

Non-infectious disorders
• Incontinentia pigmenti
• Eosinophilic pustulosis (eosinophilic pustular folliculitis) of the scalp
• Infantile acropustulosis
• Omenn type of severe combined immunodefi ciency
• Buckley–Job hyperimmunoglobulin syndrome
• Self-healing histiocytosis


Sterile transient neonatal papulopustular eruptions
 Erythema toxicum neonatorum (ETN)

 Transient pustular melanosis (TPM)


Erythema toxicum neonatarum
 is the most common transient rash in healthy term neonates, affecting 30-70 % of the newborns


 First and forth days of life and lasts 2 or 3 days
 The cause of ETN is not yet established
 no predilection according to sex
 White > Black

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 Lesions are located mostly on the trunk, with a predilection for the back, but are readily found on the upper arms, thighs and face

 The palms and soles are relatively spared.
 Flea bite picture (70%)
 30% pustular

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Neonatal acne
 neonatal cephalic pustulosis is related to malassezia colonisation

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Miliaria
 The term miliaria is used to describe a group of transient eccrine disorders.
 Occlusion of sweat ducts at various levels, resulting in leakage of sweat in the epidermis or papillary dermis

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Milia
 Milia are noted in 30 – 50% of neonates. They consist of 1 – 2 mm white or yellow papules on the nose, chin, cheeks and forehead.

 The nose is predominantly affected. Less commonly, lesions may occur on the trunk and extremities.

 Milia are epidermal cysts derived from the pilosebaceous follicles

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Bohn nodule
 Whitish-yellow nodules which appear on the gums and hard palate in a large percentage of new-born babies.
 Causes
Bohn’s nodules are odontogenic cysts that arise from the dental lamina. They are filled with keratin.
Epstein pearls are epithelial inclusion cysts.
The condition is harmless but worries new mothers who may mistake the nodules for emerging teeth.

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Perianal dermatitis of neonate
 is an area of erythema centred on the anus and occasionally accompanied by erosion and bleeding.
 Early lesions are small erythematous macules 2 – 3 mm in size.
 This condition is usually attributed to formula milk feeding in the newborn and abnormal faecal pH .
 It is observed between the fourth and seventh days of Life .
 Perianal dermatitis is 6.5 times more frequent in premature babies.

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Cradle cap

 

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 Seborrheic dermatitis is an extremely common rash characterized by erythema and greasy scales Many parents know this rash as “cradle cap” because it occurs most commonly on the scalp.
 Other affected areas may include the face, ears, and neck. Erythema tends to predominate in the flexural folds and intertriginous areas, whereas scaling predominates on the scalp.
 Because seborrheic dermatitis often spreads to the diaper area, it is important to consider in the evaluation of diaper dermatitis

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Mongolian spot

 

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Stork bite

 

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Port wine stain

Angel kiss

 

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Infantile hemangioma

 

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خواندن 2875 دفعه
Image

دکتر محمد ایمانی

متخصص پوست ، مو و زیبایی


پزشک: دکتر ایمانی
پرسشگر: Elmertet
تاریخ: دوشنبه, 05 مهر 1395 09:39
وضعیت: پاسخ داده شده

پرسش:
با سلام و خسته نباشید... جناب دکتر از سن 18سالگی در گیر بیماری ویتیلیگو هستم و بالای 60درصد بدنم رو درگیر کرده ولی رنگ لکه ها خیلی سفید نیست که تابلو باشه ...اولین سوالم اینه که این لکه ها مگه رنگ های سفیده کم رنگ پر رنگ داره؟ چون الان رنگشون مثل رنگ پوسته خیلی سفیده فرد عادیه... و دومین سوالم...آیا حقیقت داره در بیمارستان رازی آمپول هایی وجود داره و تزریق میکنن و پوست سفید میشه؟ هزینه اش چقدره؟ممنون لطفا پاسخ بدید

آقاي ساسان سلام

اگر بيماري در حال پيشرفت باشد،نقاط جديد بدن كه تازه دارند رنگدانه از دست مي دهند ولي هنوز روند پيشرفت ادامه دارد،خيلي سفيد نيستند،در خصوص سوال دوم،چنين آمپول و درماني وجود ندارد،بهترين درمان براي شما نور درماني هست .

 

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