Dr, Z, Badiee neonatologist. Neonatal dermatosis.

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Dr, Z, Badiee neonatologist

Neonatal dermatosis

Common transient cutaneous lesions Erythema toxicum Milia Miliaria Transient neonatal pustular

melanosis Salmon patch Mongolian spot

Erythema toxicum

Begin: 24-72 h New lesions may occur until 2-3 weeks of age More common in term Erythematous bases + 1-3 mm papule (white or

pale yellow) Resemble flea bite Asymptomatic The sites of predilection : the face, trunk, proximal arms and buttocks

whereas palm and sole involvement is unusual

Erythema toxicum Red macular areas and wheals range

from a few millimeters to several centimeters with superimposed 1 to 2mm papules and pustules

The lesions may be few in number but more often are present in large numbers Etiology : unknown

Gram stain and culture : negative Wright or Geimsa stain: eosinophils Resolution: 6-14 days

Erythema toxicum

Transient neonatal pustular melanosis Incidence: from 0.16 to 15% and the

disorder is more common in black It is a benign condition of term

neonates characterized by: the presence at birth of pustules or

vesicles without surrounding erythema

Transient neonatal pustular melanosis These vesicopustules rupture easily,

with subsequent formation of pigmented macules that are characteristically surrounded by a collarette of scale. These macules may persist for months but usually fade spontaneously within 3 to 4 weeks.

Transient neonatal pustular melanosis

Most commonly affected areas include:

the forehead posterior ears chin, neckupper chest, back, buttocks, abdomen,

and thighs but all areas may be affected, including

the palms and soles.

Transient neonatal pustular melanosis

Wright or Giemsa staining of the pustular contents show neutrophils and occasional eosinophils.

No organisms are observed and bacterial and viral cultures are negative.

Skin biopsy shows intracorneal or subcorneal pustules.

Pustular melanosis

Salmon patch

Other names: nevus simplex transient macular stains Angel kiss

Salmon patch

Present in up to 70% normal newborn

Common sites: nape, eyelid, glabella

Most of them fade by 1 year of age Lesions on neck: more persistent 25% of adult had neck lesion

Salmon patch

Mongolian spot The most common pigmented lesion Most common in: african- american Asian Native american Common site: lumbosacral area Macular, gray-blue Lack of sharp border May cover an area of 10 cm or larger

Mongolian spot

Delay disappearance of dermal melanocytes

Most of them disappear during first years

Abberant lesions may more likely to persist

Mongolian spot

Harlequine color change Most common :First 2- 4 days of life May occur until 3 weeks More common in LBW infants The dependent side : red Upper side: pale Sharp midline demarcation Cause: imbalance in autonomic

regulatory mechanism of cutaneous vessels

Harlequine color change

miliaria obstructions of the eccrine duct resulting

in rupture of the ducts and blockage of normal sweating into the skin.

The level of obstruction determines the clinical manifestations.

It can be seen in up to 15% of neonates occurring more commonly in warm

climates, in nurseries without air-conditioning and in febrile infants.

Miliaria crystalina is the most common type of miliaria is manifested by minute, non-inflammatory

vesicles without surrounding erythema. These lesions are asymptomatic, superficial

and may appear like dewdrops on the skin. Commonly affected sites : forehead and upper trunk Miliaria crystalina represents rupture of

the eccrine duct at the level of the stratum corneum

Miliaria crstalina

Miliaria rubra is due to intraepidermal obstruction of

the sweat duct with sweat leakage into the duct and a secondary local inflammatory response.

Lesions are 1-3mm erythematous, non-follicular papules, vesicles or pustules.

Common sites include the face, neck and trunk.

Miliaria rubra

Miliaria rubra occurs later than miliaria crystalina, usually beyond the second week of life.

Occasionally it can progress to pustular lesions (miliaria profunda)

most prominent on the trunk and extremities, and reflects eccrine ductal occlusion at the dermo-epidermal junction.

Milia These commonly occur on the face

and scalp, and consist of tiny white papules which are usually discrete.

They can however occur anywhere, and may be present at birth or appear subsequently.

They usually resolve within a few months without treatment.

milia Milia are inclusion cysts which contain

trapped keratinised stratum corneum.

Similar lesions may be seen in the mouth in some infants:

When on the hard palate, they are referred to as Epstein's pearls

when on the alveolar ridges, they are called alveolar cysts or Bohn's nodules.

Neonatal Acne may be present at birth, or develop

over the first 2-4 weeks of life. Small red papule and pustules on the

face There is controversy over whether it

is truly acne or whether it represents a form of pustular disorder in the newborn period.

As a result, the term neonatal cephalic pustulosis has been mooted.

Neonatal Acne

The condition consists of pustules over the cheeks primarily, but also involves other areas of the face and the scalp.

As opposed to infantile acne (which develops after 2 months) and acne of adolescence, there are no comedomes in the neonatal form.

It may be difficult to differentiate between acne and miliaria rubra.

Neonatal acne resolves spontaneously over several weeks

Acropustulosis of infancy

is a chronic or recurrent benign condition of very pruritic vesicles and pustules occurring on the hands and feet

its etiology is unknown and it affects primarily black boys

Acropustulosis of infancy Onset: birth to 10 months continue throughout infancy and early

childhood Infants and children often present with

severe prutitus, sleep disturbance, and appetite loss.

Clinical manifestations are limited to the skin, and affected neonates are healthy otherwise.

Acropustulosis of infancy Cutaneous lesions consist of vesicopustules

without surrounding erythema characteristically involving palms, soles,

dorsal hands and feet, and sides of fingers and toes.

Crops of lesions may appear in cycles of two to four weeks, with individual lesions lasting three to seven days.

The number of lesions is greatest in the early episodes, becoming less with subsequent episodes until permanent resolution occurs at 2 to 3 years of age.

Sucking Blisters These lesions are present at birth, most

often over the dorsal and lateral aspect of the wrist.

Less often, they may be noted more proximally in the forearm.

The infant is noted to exhibit excessive sucking activity.

The absence of lesions in other parts of the body and the otherwise well appearance of the infant would rule out pathological disorders presenting with similar lesions

Sucking Blisters

Aplasia cutis Local absence of skin at birth Most often: on the scalp midline Occatinaly other parts: trunk, extrimity

Possible ethiology: incomplete closure of the neural tube Localized vascular insufficiency Intrauterin infection large scalp defet: associated with trisomy 13 Management: observation, prevention of

infection, surgical excision, skin graft.

Cutis aplasia

Aplasia cutis

Subcutaneous fat necrosis

Localized Sharply circumscribe Appear 1-4 weeks after delivery

Small nodules or large plaques

Cheeks Buttocks Back Arms thighs

The affected fat : firm, mobile Overlying skin: red or violaceous Histology: granulomatous reaction

in the fat Hypercalcemia may develop

fat necrosis

Non bullous impetigo

Non-bullous impetigo

Non-bullous impetigo is the most common form of impetigo. Lesions begin as papules that progress to vesicles surrounded by erythema. Subsequently they become pustules that enlarge and rapidly break down to form thick, adherent crusts with a characteristic golden appearance

this evolution usually occurs over about one week Lesions usually involve the face and extremities. Multiple lesions may develop but tend to remain well localized. Regional lymphadenitis may occur, although systemic symptoms are usually absent

Bullous impetigo

Bullous impetigo is a form of impetigo seen primarily in young children in which the vesicles enlarge to form flaccid bullae with clear yellow fluid, which later becomes darker and more turbid; ruptured bullae leave a thin brown crust

Usually there are fewer lesions than in non-bullous impetigo, and the trunk is more frequently affected. Bullous impetigo in an adult with appropriate demographic risk factors should prompt an investigation for previously undiagnosed human immunodeficiency virus (HIV) infection

Bullous impetigo is due to strains of S. aureus that produce exfoliative toxin A, a toxin that causes loss of cell adhesion in the superficial epidermis by targeting the protein desmoglein 1

Bullous impetigo

Epidermolysis bullosa (EB)

comprises a clinically and genetically heterogeneous group of rare inherited disorders characterized by marked mechanical fragility of epithelial tissues with blistering and erosions following minor trauma.

Nail erosions with periungual granulomatous tissue and incipient onycholysis in generalized severe JEB.

Neck vesicles in neonate with herpes simplex virus infection

Hemorrhagic crusts and vesicles due to herpes simplex virus infection are present on the face of this infant with underlying atopic dermatitis. Eczema herpeticum

Candida diaper dermatitis in an infant

Dr, Z, Badiee neonatologist. Neonatal dermatosis.

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