dr, z, badiee neonatologist. neonatal dermatosis
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Dr, Z, Badiee neonatologist
Dr, Z, Badiee neonatologist
Neonatal dermatosis
Dr, Z, Badiee neonatologist
Common transient cutaneous lesions Erythema toxicum Milia Miliaria Transient neonatal pustular
melanosis Salmon patch Mongolian spot
Dr, Z, Badiee neonatologist
Erythema toxicum
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
Erythema toxicum
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
Transient neonatal pustular melanosis
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
Pustular melanosis
Dr, Z, Badiee neonatologist
Pustular melanosis
Dr, Z, Badiee neonatologist
Pustular melanosis
Dr, Z, Badiee neonatologist
Salmon patch
Other names: nevus simplex transient macular stains Angel kiss
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
Salmon patch
Dr, Z, Badiee neonatologist
Salmon patch
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
Mongolian spot
Delay disappearance of dermal melanocytes
Most of them disappear during first years
Abberant lesions may more likely to persist
Dr, Z, Badiee neonatologist
Mongolian spot
Dr, Z, Badiee neonatologist
Mongolian spot
Dr, Z, Badiee neonatologist
Mongolian spot
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
Harlequine color change
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
Miliaria crstalina
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
milia
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
Acropustulosis of infancy
Dr, Z, Badiee neonatologist
Acropustulosis of infancy
Dr, Z, Badiee neonatologist
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
Sucking Blisters
Dr, Z, Badiee neonatologist
Sucking Blisters
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
Cutis aplasia
Dr, Z, Badiee neonatologist
Aplasia cutis
Dr, Z, Badiee neonatologist
Subcutaneous fat necrosis
Localized Sharply circumscribe Appear 1-4 weeks after delivery
Small nodules or large plaques
Cheeks Buttocks Back Arms thighs
Dr, Z, Badiee neonatologist
Subcutaneous fat necrosis
The affected fat : firm, mobile Overlying skin: red or violaceous Histology: granulomatous reaction
in the fat Hypercalcemia may develop
Dr, Z, Badiee neonatologist
fat necrosis
Dr, Z, Badiee neonatologist
Subcutaneous fat necrosis
Non bullous impetigo
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
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
Dr, Z, Badiee neonatologist
Bullous impetigo
Dr, Z, Badiee neonatologist
Bullous impetigo
Dr, Z, Badiee neonatologist
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.
Dr, Z, Badiee neonatologist
Dr, Z, Badiee neonatologist
Nail erosions with periungual granulomatous tissue and incipient onycholysis in generalized severe JEB.
Dr, Z, Badiee neonatologist
Neck vesicles in neonate with herpes simplex virus infection
Dr, Z, Badiee neonatologist
Hemorrhagic crusts and vesicles due to herpes simplex virus infection are present on the face of this infant with underlying atopic dermatitis. Eczema herpeticum
Dr, Z, Badiee neonatologist
Candida diaper dermatitis in an infant
Dr, Z, Badiee neonatologist
Dr, Z, Badiee neonatologist
Dr, Z, Badiee neonatologist
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