Neonatal rashes Flashcards
When do you develop the following embryologically?
- Nails
- Hair
- All layers of epidermis
- Epidermal barrier
- Nails: 8-9 wks
- Hair: 17-19 wks
- All layers of epidermis: 24 wks
- Epidermal barrier: 35 weeks
When is erythema toxicum first noted?
What is a key feature of it?
What type of cells are seen?
What does it resolve?
24-48h post delivery
Spares palms/soles
Eosinophilic
Lesions last <1 day, settles within a week
Name this rash
Erythema toxicum neonatorum
When is transient neonatal pustular melanosis first noted?
When do they resolve?
What cells are seen in the pustule?
At birth (5% darker skins, <1% white)
Weeks to months
Neutrophils
Name this rash
Transient neonatal pustular melanosis
Name this rash
Miliaria rubra
What layer of skin does miliaria crystallina occur?
What layer of skin does miliaria rubra occur?
Eccrine sweat ducts
Spinous layer
Name this rash
Neonatal cephalic pustulosis
When is neonatal cephalic pustulosis typically seen?
When does it disappear?
2-3 weeks of life
By 3 months
Name this rash
Congenital candidiasis
When do lesions present for congenital candidiasis?
What does the rash look like?
Which population is at high risk of disseminated disease?
What is the mortality rate of disseminated systemic candidiasis?
How long do you treat with fluconazole?
At birth or first few days of life
widespread vesiculopustular eruption with fine scale
Premature/low birth weight infants
20%
21 days after microbiological clearance
Name this rash
Neonatal Candidiasis
When do lesions present for neonatal candidiasis?
Describe the appearance of lesions.
Where do the lesions tend to be located?
How are they treated?
1 week
Erythematous patches, satellite papules/pustules
Flexures and diaper area
Topical antifungal (imidazole = cannestan)
List 3 features of congenital HSV?
Which pregnancies are at highest risk?
What type of infection carries a 2% risk?
When are lesions noted with congenital HSV?
- Aplasia cutus
- Microcephaly
- Temporal lobe encephalitis
- Chorioretinitis
Primary infection during pregnancy (57%)
Recurrent infection
Birth or within 48h
What are the 3 types of neonatal HSV?
What is the incubation period for HSV?
What is the recommended treatment?
- Mucocutaneous
- Disseminated
- CNS
4-21 days
IV Acyclovir 14-21 days, prophylaxis x 6 months
Name this rash
Neonatal lupus
List 3 complications of neonatal lupus
What type of antibodies are seen with this disorder?
- Thrombocytopenia
- Hepatosplenomegaly
- Congenital heart block
Maternal anti-Ro and anti-La
List 3 physical causes of blistering in a neonate
- Iatrogenic
- Sucking blister
- Electrodes from fetal scalp monitoring
- Instrumental delivery
- Iodine/alcohol burn
List 2 inflammatory causes of blistering in a neonate
- Bullous mastocytosis
- Urticaria pigmentosis
List 3 autoimmune causes of blistering in a neonate
- Bullous pemphigoid
- Chronic bullous dermatosis of childhood
- Maternal bullous disease
List 3 genetic causes of blistering in a neonate
- Epidermolysis bullosa
- Incontinentia pigmenti
- Epidermolytic ichthyosis
Name this skin disorder
Staphylococcal scalded skin syndrome
Name the location the exfoliative toxin attacks in SSSS
Desmoglein-1
Name this rash
What is the deficiency?
List the triad
Acrodermatitis enteropathica
Zinc deficiency
- Alopecia
- Diarrhea
- Periorificial rash/diaper rash
Name this rash
Incontinentia pigmenti
List the 4 phases of incontinentia pigmenti
What gene is implicated?
What is the inheritence pattern?
- Vesicular
- Verrucal/Crusting
- Hyperpigmented
- Hypopigmented
IKBKG (NEMO)
X-linked dominant
Name this skin disorder
Epidermolytic Ichthyosis
Where are the mutations located for epidermolytic ichthyosis?
Which mutation location is associated with palmoplantar keratoderma?
Keratin 1 and 10
Keratin 1
Where is the mutation located in EB simplex?
What is the affected gene in dystrophic EB?
What is the affected gene in junctional EB?
What is the affected gene in Kindler syndrome?
Keratin 5 and 14
COL7A1
Collagen 17
KIND1
List 3 complications of dystrophic EB
What is the expected life expectancy for junctional EB?
- Cardiomyopathy
- Contractures
- Squamous cell carcinoma
- Stenosis of the esophagus
5-6 months
List 3 features of Kindler syndrome
- Acral blisters in infancy
- Photosensitivity
- Poikiloderma
What is the implicated transporter in infantile hemangiomas?
What type of blood flow is present in infantile hemangiomas?
GLUT1+
Fast flow
What associations are seen with PHACES?
- Posterior fossa anomalies
- Hemangioma (segmental)
- Artery abnormalities
- Cardiac anomalies/coarctation
- Eye abnormalities
- Sternal abnormalities
What associations are seen with SACRAL syndrome?
- Spinal dysraphism
- Anogenital anomalies
- Cutaneous
- Renal/urological Anomalies
- Lumbosacral hemangioma
What is the location that carries the highest incidence of Sturge-Weber syndrome?
What are 2 associations of SWS?
Where is the mutation?
Forehead
- Glaucoma (ipsilateral)
- Leptomeningeal angiomas
- Seizures
- Intellectual delay
Somatic mosaic mutation in GNAQ gene
Name this skin lesion
Sebaceous nevus
What type of cells are found in sebaceous nevi?
What can happen in adolescence?
What is the recommendation?
Sebaceous glands
Proliferate and become warty/lumpy
No longer excise. Monitor later in life.
List the classification of congenital melanocytic nevi
What do they need to be monitored for?
Who is at highest risk?
What gene is affected?
- Small (<1.5 cm)
- Medium (1.5-20 cm)
- Large (20-40 cm)
- Giant (>40 cm)
Melanoma (neurocutaneous and CNS melanoma)
Giant CMN and those with satellite lesions
NRAS codon 61
