Newborn, nappy rash and other lesions Flashcards
What is the skin at birth covered with? Describe it?
1) Vernix Caseosa:
- Chalky-white great coat mainly composed of water, proteins and lipids, it protects the skin in utero from the amniotic fluid.
- Shedding of the vernix coincides with the maturation of the trans-epidermal barrier.
Problems with skin in pre-term infants?
1) Thin skin - poorly keratinised, lacks subcutaneous fat and has markedly increased trans-epidermal water loss compared to the term infant.
2) Pre-term infant unable to sweat until few weeks old, term infant can sweat from both.
Lesions in newborn infants that resolve spontaneously: (Capillary haemangioma (stork bites))
1) Distention of the dermal capillaries - causing pink macules on the mid-forehead, upper eye lid and nape of neck.
2) Eyelid macules fade gradually over 1st year, those on the neck become covered with hair.
Lesions in newborn infants that resolve spontaneously: (Erythema toxicum (neonatal urticaria))
1) Common rash appearing at 2-3 days of age
2) Consisting of white pinpoint papules at the centre of an erythematous base.
3) Fluid consists of eosinophils.
4) Concentrated on trunk - come and go at different sites.
Lesions in newborn infants that resolve spontaneously: (Milla)
1) White pimples on nose and cheeks - caused by retention of keratin and sebaceous material in the pilaceous follicles.
Lesions in newborn infants that resolve spontaneously? (Mongolian black spots)
1) Blue/black macular discolouration at the base of the spine and buttocks.
2) Occasionally occurs on legs.
3) More common in afro-caribs and asian infants.
4) It slowly fades over the first few years, sometimes can be confused as bruises - mistakenly leading to thoughts of non-accidental injury.
Port- Wine stain (Naevus Flameus)?
1) Present from birth and grows with infant
2) Caused by vascular malformation of the capillaries in the dermis.
3) Disfiguring lesions can be improved with laser therapy.
Strawberry Naevus (Cavernous haemangioma):
1) Often not present at birth but develops in first month of life and may be multiple.
2) More common in pre-term infants
3) Increases in size until 3-15 months then it gradually decreases
4) No treatment required unless lesion interferes with vision or airway - ulceration and haemorrhage can result in complications.
5) With large lesions - thrombocytopenia may occur and will require therapy with steroids or interferon-alpha.
Bullous impetigo:
1) Uncommon but potentially serious blistering form of impetigo (most superficial form of bacterial infection seen in newborn).
2) Caused by Staphylococcus Aureus
3) Treatment with systemic penicillinase resistant penicillin: Clindamycin
Melanocytic Naevi (moles)?
1) Congenital pigmented naevi involving extensive areas of skin (>9cm) are rare, but disfiguring and carry a 4-6% lifetime risk of subsequent malignant melanoma. (these require prompt referral to Paeds dermatologist and plastic surgeon).
2) Increasingly common as children get older and the presence of large numbers in an adult may be indicative of childhood sun exposure. (Prolonged sun exposure should be avoided and sunscreen should be used).
3) Risk factors for melanoma; Family history, large number of melanocytic naevi, fair skin & repeated exposure to sunlight, giant melanocytic naevi.
Albinism:
1) Caused by a defect in biosynthesis and distribution of melanin
2) Lack of pigment in the iris, retina, eyelids, eyebrows results in failure to develop fixation reflex.
3) There is pendular nystagmus and photophobia causing constant frowning.
4) Correction of refractive errors and tinted lenses may be helpful, fitting of tinted contacts from childhood may help develop fixation reflex.
5) Important cause of severe visual impairment.
6) Pale skin prone to burning and cancer.
Epidermolysis Bullosa:
1) Rare group of genetic conditions characterised by blistering of the skin and mucous membranes.
2) Autosomal recessive variants tend to be more severe (sometimes fatal) than autosomal dominant
3) Blisters occur spontaneously or followed minor trauma.
4) Mucous membrane involvement may result in oral ulceration and stenosis from oesophageal erosions.
5) In severe forms, fingers and toes may become fused and contractures of the limbs develop from repeated blistering and healing.
Treatment: Avoid injury from even minor skin trauma and treat secondary infections
Collodion Baby:
1) Rare manifestation of the inherited Ichthyoses - group of skin conditions in which the skin is dry and scaly.
2) Infants are born with a taut parchment-like or collodion-like membrane.
Treatment:
1) Emollients are usually applied to moisturise and soften skin.
2) Membrane becomes fissured and separated within a few weeks usually leaving Ichthyotic (scaly/dry skin) or less commonly, normal skin.
Irritant (Contact) Dermatitis: (Napkin rash)
- MOST COMMON NAPKIN RASH
- May occur is nappies are not changed frequently enough or if the infant has diarrhoea.
- Rash caused by the irritant effect of urine on the skin of susceptible infants.
Presentation:
1) Rash is erythematous and may have a scalded appearance.
2) Rash affects convex surfaces of buttocks, perineal region, top of thighs and lower abdomen.
3) Characteristically - flexures are spared
4) Severe form associated with erosion and ulcers
Treatment:
Mild - Protective emollients
Severe - Topical corticosteroids - topical Hydrocortisone
Candida infection:
- May cause and complicate nappy rashes.
- Rash is erythematous and, includes skin flexures - there may be satellite lesions.
Treatment: Anti-fungal agent e.g. Topical Nystatin
