SKIN FINDINGS & SKIN DISEASES IN THE NEWBORN

Dr. Ahmed A. Saad

DHMAR GENERAL HOSPITAL

REBUPLIC OF YEMEN

Structural and functional differences of adult and term infant

newbornAdult

50 μm50 μmEpidermal thickness

normalnormalCell attachements(desmosmes,

hemidesmosomes)

low Collagen and elastic fibers

normaldermis

FewerDelayed activity for 1–7

days

normalmelanosomes

low Neurologic control for 2–3 years

normal

Normal

Normal

Eccrine glands

Sebaceuos glands

low Terminal hairnormalhair

I -PHYSIOLOGIC SKIN FINDING IN THE NEWBORN

VERNIX CASEOSA

whitish-gray covering on newborn skin and

is 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 hairloss

Neonatal 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-BIRTHMARKS

COMMON BIRTHMARKS

1) Mongolian spot

2) Hemangioma

3) Port-wine stain

4) Salmon patch/Angel kiss/Stork bite/nevus flammeus nuchae

4)café au lait macules

5)Congenital nevi

III-TRANSIENT ERUPTIONS OF THE

NEWBORN

Erythema Toxicum Neonatorum

Clinical: papules and pustules that start within 48 hours of birth lasting 2-3 days; affects the

face/trunk/proximal extremities; spares the palms/soles.

Most common pustular rash(up to70%of full-term.

Usually fade over 5-7 days.

Sucking Blister

A 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 Heat

1-3mm 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

Milia

Common (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 acne

Open & 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,andintracranial calcificatons.

Varicella

Varicella 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 of

age .

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 dermatitis

Erosive

napkin dermatitis. Note

sparing in the flexures.

PSORIASIS --------Dark-red plaques, may have a silveryscale.

Nails May have pinpoint pitsCANDIDAL INFECTION--------Erythema with

fragile satellite pustules. Pinpoint satellite vesicopustulesoften present . folds often affected.OTHER CONDITIONS-------- Acrodermatitisenteropatheca,Grauloma gluteale infantum,seborrhoec dermatits ,histicytosis,impetigo…..

VI-MATERNAL SKIN DISEASES &NEW BORN

Varicella-zoster virus (VZV)

Congenital varicella: --------0–20 weeks

1-2% scaring, limb hypoplasia , multisystem involvement .

13-40weeks-------shingles in infancy 1-2%

-7-+7days---------neonatal varicella

Rubella

0-8 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 purpuricpapules, especially on head, neck, and trunk

Causes: torch, parvovirus b-19,hemolytic anemia and another .

Systemic lupus erythematosus

Neonatal 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 gestationis

5–10% of infants born to mothers with PG

have cutaneous lesions1. Transient urticarial or

vesicular lesions are most common and resolve

spontaneously within around 3 weeks

Syphilis

# 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 syphilis

Start 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 DISEASES

EPIDERMOLYSIS 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 fetus

Rare sever form of congenital ichthyosis.

Prognosis very poor.