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7th > Chapter 103 - Neonatal Dermatology > Flashcards

Chapter 103 - Neonatal Dermatology Flashcards

1
Q

Greatest risk for systemic toxicity from topically applied substances

A

Premature infants

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2
Q

Preterm infants are born ____ weeks of gestation

A

Before 37

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3
Q

Full term infants are born between ____ weeks of gestation

A

37 and 42

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4
Q

By ___ week, epidermis begins to develop

A

6th

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5
Q

By ___ week, there is stratification of fetal epidermis

A

8th

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6
Q

By ___ week, DEJ is evident

A

8th

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7
Q

By ____ week, terminal differentiation of skin appendages

A

11th and 15th

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8
Q

By ____ week, hair follicles will begin to develop

A

14th

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9
Q

By ____ week, organization into papillary and reticular dermis occurs

A

15th week

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10
Q

By ____ week, there is sebaceous gland formation

A

16th

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11
Q

By ____ week, lanugo hair production starts

A

18th

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12
Q

By ____ weeks, there is terminal differentiation in interfollicular epidermis

A

22 to 24 weeks

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13
Q

By ___ weeks, elastic fibers develop

A

22 to 24

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14
Q

By ____ weeks, lanugo hair production is complete

A

28

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15
Q

Eccrine gland development is completed during ____ but are not function until _____.

A

2nd trimester, after birth

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16
Q

Apocrine glanda are functional during ____

A

3rd trimester

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17
Q

____ contibutes significantly to lipid composition of vernix caseosa

A

Sebaceous gland products

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18
Q

By ____ week, vernix caseosa begins

A

36th

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19
Q

It is composed predominantly of water-containing corneocytes in a lipid matrix composed of nonpolar lipids such as sterol esters and TGL

A

Vernix caseosa

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20
Q

Vernix caseosa contains multiple antimicrobial peptides (3)

A

LL37
Cystatin A
Calgranulin

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21
Q

Evaluation of ff parameters (4) to indicate continuous adjustment of neonatal skin to extrauterine environment:

A

Skin thickness
Skin pH
Transepidermal water loss
Stratum corneum hydration

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22
Q

In full term neonates, TEWL is equivalent to adults except for ____ where TEWL is higher and contibute to impaired barrier function

A

Diaper area

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23
Q

One of the most visible early manifestation of adaptive process is

A

Desquamation of upper layers of stratum corneum

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24
Q

During the first ___ months of life, the thickness of stratum corneum ____, and the epidermal thickness ____, aong with formation of _____(2)____

A 
3
Decreases
Increases
1. Dermal papilla
2. Epidermal ridges
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25
Q

Normal skin pH is acidic due to (2)

A
  1. Production of free fatty acids from phospholipids

2. Production of sweat and sebum

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26
Q

In both term and preterm neonate, skin pH is initially more alkaline.
True or False

A

True

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27
Q

Ecrrine sweating is delayed both in term and preterm neonates.
True or False

A

False, delayed only in preterm

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28
Q

TEWL ___ with decreasing gestation

A

Increases

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29
Q

Functional maturation of stratum corneum begins by ____ of gestational age

A

24

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30
Q

Use of radiant warmers and phototherapy also contibute to ___ TEWL

A

Increased

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31
Q

Impaired epidermal barrier infection places preterm infant at risk for
(5)

A 
Poor thermoregulation
At risk for electrolyte imbalances
Dehydration
Infection
Increased absorption of topical agents
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32
Q

Increased skin fragility is also noted in term infants.

True or False

A

False, preterm

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33
Q

Application of petrolatum has been beneficial by decreasing TEWL but has been associated with ___fold increase in incidence of systemic candidiasis in extremely LBW infants (

A

3, 1000

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34
Q

Neonates receiving petrolatum based emollient therapy should be carefully monitored for infections, particularly very low birthweight infants (< ___g)

A

1500

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35
Q

Recommendations for bathing in skin care include

A

Bathing in water 2-3 times per week for no more than 5-10 minutes
Make use of soap free cleanser
Application of emollient after bathing

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36
Q

Use of skin cleanser has no effect on TEWL, skin surface pH, stratum corneum hydration
True or False

A

True

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37
Q

Preterm neonates can have local or systemic toxicity from soap, lotions or other cleansing solutions.
True or False

A

True

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38
Q

Transient dermatoses of neonate usually resolve by ____ days of age

A

30

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39
Q

Result from subQ edema over presenting part of the head owing to pressure against the cervix

A

Caput succedaneum

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40
Q

Soft to palpation with ill defined borders

A

Caput succedaneum

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41
Q

(+) petechia and ecchymoses

A

Caput succedaneum

42
Q

Edema resolves spontaneously over 7-10days

A

Caput succedaneum

43
Q

Results from rupture of diploic and/or emissary veins and subsequent subperiosteal collection of blood

A

Cephalohematoma

44
Q

It is associated with birth trauma ;use of vacuum extraction vaginal delivery

A

Cephalohematoma

45
Q

Does not cross the suture lines

A

Cephalohematoma

46
Q

Unilateral, firm to palpation

A

Cephalohematoma

47
Q

Underlying skull fracture may be present in caput succedaneum.
True or False

A

False, cephalohematoma

48
Q

Associated with birth trauma

A

Cephalohematoma

Subgaleal hemorrhage

49
Q

Bleeding between the periosteum of skull and galea due to damage of emissary veins

A

Subgaleal hemorrhage

50
Q

Extensive hemorrhage leading to anemia and neonatal hyperbilirubinemia

A

Cephalohematoma

Subgaleal hemorrhage

51
Q

May result into hypovolemic shock or disseminated intravascular coagulation

A

Subgaleal hemorrhage

52
Q

Pinpoint to 2mm papules representing benign superficial epidermal inclusion cysts commonly on face in newborns

A

Milia

53
Q

Milia in the oral cavity are called

A

Epstein pearls

54
Q

Milia resolves spontaneously within a few weeks of life.

True or False

A

True

55
Q

Minute (<1mm) yellow macules or papules commonly seen at the opening of pilosebaceous follicles over nose and central forehead of term newborns

A

Sebaceous gland hyperplasia

56
Q

At least ____% of normal newborns have sebaceous gland hyperplasia

A

50

57
Q

Sebaceous gland hyperplasia resolves spontaneously by ____ mos of age

A

4 to 6

58
Q

Sebaceous gland hyperlasia occur secondary to _____

A

Maternal androgen stimulation

59
Q

It is an idiopathic skin condition seen in up to 75% of term newborns in 24-48 hours of age but may be delayed up to 7-10 days

A

Erythema toxicum neonatorum

60
Q

Characteristic of ETN

A

Blotchy erythematous patches (1-3cm) with (1-4mm) central vesicle or pustule

61
Q

ETN vs TPNM

  1. Appear at birth
  2. Appear at 24-48 hours of age
  3. May be delayed until 10 days of age
  4. May appear as late as 3 weeks of age
  5. Disappear in 5-7 days
  6. Clears spontaneously by 2-3 weeks
  7. Without residua
  8. Peripheal blood eosinophilia
  9. Predominance of neutrophils on Wright stained specimens
  10. Spares palms and soles
A
      1. 9- TPNM

2. 3. 6. 7. 8. 10.- ETN

62
Q

Follicular based lesions are characteristic of TPNM

True or False

A

False, ETN

63
Q

It is characterized by multiple superficial vesicles and pustules, with ruptured lesions evident as collarette of scale; prevalent in newborns with darkly pigmented skin

A

Transient Neonatal Pustular Dermatosis

64
Q

Lesions can occur anywhere but are common on the forehead and mandibular area and may involve palms and soles often disappearing in ___

A

Transient Neonatal Pustular Dermatoses; 5-7 days

65
Q

Minute superficial subcorneal vesicles

A

Miliaria crystallina

66
Q

Common disorder that results from fever or overheating

A

Miliaria or Heat rash

67
Q

Possible causes of miliaria crystallina

A
  1. Eccrine gland occlusion by sweat
    Or
    2.extracellular polysaccharides of Staphylococcus epidermidis
68
Q

Blotchy or lace like pattern of dusky erythema over trunk and extremities of neonates that occur with exposure to cold environments and disappears with rewarming

A

Mottling

69
Q

physiologic mottling is due to

A

Immature autonomic control of cutaneous vascular plexus

70
Q

Physiologic mottling disappears with rewarming, differntiating it from

A

Cutis marmorata telangiectatica congenita

Livedo reticularis

71
Q

It is a condition wherein when the neonate is placed on one side, an erythematous flush with sharp demarcation at midline develops on dependent side and the upper half of the body becomes pale

A

Harlequin color change

72
Q

Harlequin color change is a rare vascular phenomenon that occurs in full term newborns
True or False

A

True, also in preterm, LBE infants exposed to hypoxia or prostaglandins

73
Q

Harlequin color change may persist for as long as ____ but seldom seen after ____; if persistent there might be an underlying neurologic disorder

A

20 mins; 10 days of age

74
Q

Neonatal acneiform facial lesions occur in ___ % of newborns

A

50

75
Q

Most common neonatal acneiform eruption attributed to overgrowth of Malassezia

A

Neonatal cephalic pustulosis

76
Q

Treatment for neonatal cephalic pustulosis

A

Ketoconazole topical

77
Q

True infantile acne can be distingushed from neonatal cephalic pustulosis with: (4)

A

Age of onset
Presence of comedones
Acneiform cysts
Scars

78
Q

Blue gray patches located on lumbosacral area or buttocks: seen in ___% of infants of color and 5% of white infants

A

Mongolian spots; dermal melanocytosis

80-90%

79
Q

Solitary or few well-demarcated tan macules or oatches

A

Cafe-au-lait macules

80
Q

Multiple CALMs should raise possibility of

A

NF1

81
Q

A large geographic CALM with ‘coast of Maine’ appearance is mot likely a marker for

A

McCune-Albright syndrome

82
Q

Tardive congenital melanocytic nevi may appear any time before ___

A

2 years old

83
Q

CMN enlarge proportionally with age and is expected to increase:
___ on the head
___ on the lower extremities
___ on other sites

A
  1. 7x on head
  2. 3x on lower extremities
  3. 8x on other sites
84
Q 
CMN are classified based on size:
Small:
Medium:
Large:
Giant:
A 
Small:<1.5cm
Medium
M1 1.5 to 10cm
M2 11-20cm
Large
L1 21-30cm
L2 31-40cm
Giant
G1 41-60 cm
G2>60cm
85
Q

Risk factors for neurocutaneous melanocytosis

A
  1. Large or giant CMN with posterior axial location or if
  2. More than 20 satellite nevi are present
  3. Newborns with more than 2 medium sized CMNS
86
Q

Complications of large or giant CMN

A

Melanoma

Neurocutaneous melanocytosis

87
Q

Complications of neurocutaneous melanocytosis

A

Obstructive hydrocephalus

Primary CNS melanoma

88
Q

Pigmentary mosaicism or patterned dyschromatosis crosses the midline.
True or False

A

False, does not cross

89
Q

3 or more nevus depigmentosus should prompt evaluation for

A

Tuberous sclerosis

90
Q

Nevus anemicus vs nevus depigmentosus

  1. Borders of lesion remain crisp with diascopy
  2. Borders of lesion disappear with diascopy
  3. Hypersensitivity to catecholamines
A

Nevus depigmentosus 1.

Nevus anemicus 2. 3.

91
Q

Superficial vascular ectasia of capillaries found on glabella, upper eyelids, nuchal area

A

Nevus simplex

92
Q

Salmon patch, stork bite, angel kiss fade over the first ____ years of life

A

2

93
Q

Nevus simplex occurs in high frequency in all races.
____% of white infants
____% of black infants

A

70% of white

59% of black

94
Q

Majority of nevus simplex birthmarks fade, except for those on ____

A

Occiput

95
Q

Most common tumors of infancy

A

Infantile hemangioma

96
Q

Benign neoplasms (2) that occur within a nevus sebaceus

A

Trichoblastoma

Syringocystadenoma papilliferum

97
Q

Widespread nevus sebaceus + increased risk of abnormalities in the CNS, eye, or skeletal symptoms

A

Schimmelpenning syndrome

98
Q

Epithelial ectoderm separates from neural ectoderm by ___AOG

A

3rd- 5th

99
Q

Milia when persistent may be associated with ff disorders

A

Bazex Dupre Christol

100
Q

Peripheral blood eosinophilia may occur in ___% of ETN patients and associated with numerous lesions

A

20

101
Q

Solitary intact oval or linear blisters, superficial erosions, or crusts, arising on noninflamed skin

A

Sucking blisters

102
Q

Neurocutaneous melanocytosis RF

A

Posterior axial location
More than 20 satellite nevi
More than 2 medium sized congenital nevi

7th (23 decks)

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