Sec 19 From Birth to Old Age Flashcards
Hallmark of prematurity (gestational age less than 37 weeks)
Increased skin fragility
Subcutaneous edema over the presenting part of the head and is a common occurrence in newborns; soft to palpation, and borders are ill-defined; resolve spontaneously in 7–10 days
Caput succedaneum
Subperiosteal collection of blood and is less common. Both lesions are due to shearing forces on the scalp skin and skull during labor; bounded by the suture lines of the skull and often feels fluctuant; resolve spontaneously over several weeks
Cephalohematoma
Multiple pinpoint- to 1-mm papules representing benign, superficial keratin cysts. They are seen most commonly on the nose of infants and may be present in the oral cavity. They are expected findings in the newborn and resolve spontaneously within a few weeks of life.
Milia
Milia in the oral cavity
Epstein’s pearls
Tiny (<1-mm) yellow macules or papules are seen at the opening of each pilosebaceous follicle over the nose and cheeks of term newborns. It is a benign condition that clears spontaneously by 4–6 months of age.
Sebaceous Gland Hyperplasia
An idiopathic, common condition seen in up to 75% of term newborns. It is rarely seen in premature infants. Blotchy erythematous macules 1–3 cm in diameter with a 1–4-mm central vesicle or pustule are seen. They usually begin at 24–48 hours of age, but delayed eruption as late as 10 days of age has been documented. These follicular-based lesions can be located anywhere but tend to spare the palms and soles. A smear of the central vesicle or pustule contents will reveal numerous eosinophils on Wright-stained preparations.
Erythema Toxicum Neonatorum
An idiopathic pustular eruption of the newborn that heals with tiny brown-pigmented macules. More prevalent among newborns with darkly pigmented skin. Lesions are usually present at birth or shortly thereafter, but may appear as late as 3 weeks of age, as superficial vesicles and pustules, with ruptured lesions evident as collarettes of scale. Pigmented macules are also often present at birth or develop at the sites of resolving pustules or vesicles within hours or during the first day of life. Lesions can occur anywhere but are common on the forehead and mandibular area. The palms and soles may be involved. Smear of the vesicle or pustule contents will reveal a predominance of neutrophils.
Transient Neonatal Pustular Melanosis
A blotchy or lace-like pattern of dusky erythema over the extremities and trunk of neonates that occurs with exposure to cold air due to immaturity of the autonomic control of the cutaneous vascular plexus. This disappears on rewarming. Resolves spontaneously by 6 months of age
Mottling
Rare vascular phenomenon occurring in low-birthweight infants. When the infant is placed on one side, an erythematous flush with a sharp demarcation at the midline develops on the dependent side, and the upper half of the body becomes pale. The color change usually subsides within a few seconds of placing the baby in the supine position but may persist for as long as 20 minutes. Seldom seen after 10 days of age
Harlequin color change
May be present at birth as the result of intrauterine sucking, but are more commonly seen during the first weeks of life. They are usually solitary, intact oval or linear blisters, erosions, or drying crusts, arising on noninflamed skin of the dorsal-radial aspect of forearms, wrists, or fingers or on the upper lip. They resolve within a few days.
Sucking blisters
This benign eruption appears to be hormonally mediated and has been attributed to overgrowth of Malassezia sp. Most cases resolve spontaneously, but the eruption can be treated topically with ketoconazole, benzoyl peroxide, or erythromycin.
Benign Cephalic Pustulosis
A transient circumscribed patch of nonscarring alopecia develops at the occiput in many infants. The hair loss may be gradual or sudden, and may occur as soon as the first few days of life.
Telogen Effluvium
A form of nonscarring hair loss noted at 2–5 years of age as a triangular-, oval-, or lancet-shaped area of alopecia at the frontotemporal scalp. Often, a thin row of hair separates the affected area from the forehead. The terminal hairs are replaced by vellus hair. The condition is often mistaken for alopecia areata; however, distinguishing features include the typical location and shape, the presence of vellus hairs, and the absence of exclamation point hairs
Triangular Temporal Alopecia
Most common dermatophyte for Tinea capitis in infancy
Trichophyton tonsurans
Represent an excess of one or more of the normal components of skin per unit area: blood vessels, lymph vessels, pigment cells, hair follicles, sebaceous glands, epidermis, smooth muscle, collagen, or elastin.
Birthmarks
Two most common birthmarks
Nevus simplex
Mongolian spot
Represents a capillary malformation of the skin. It occurs most commonly on the glabella, upper eyelids, and nuchal area.Appears with high frequency in all races, occurring in 70% of white infants and 59% of black infants.
Nevus simplex
Represent collections of dermal melanocytes, are seen in 80%–90% of infants of color but in only 5% of white infants.
Mongolian spots
Most common tumors of infancy
Infantile hemangiomas
Characterized by persistent coarse cutis marmorata, telangiectasia, and sometimes associated underlying cutaneous atrophy and ulceration. Its incidence is sporadic, and its etiology is obscure. Theories of vascular malformation are currently favored. Diagnosis is usually evident on clinical examination.
Cutis Marmorata Telangiectatica Congenita
Characterized by firm, circumscribed, reddish or purple subcutaneous nodules or plaques that appear over the back, cheeks, buttocks, arms, and thighs. The lesions usually begin within the first 2 weeks of life and resolve spontaneously over several weeks.
Subcutaneous fat necrosis of the newborn
Diffuse hardening of the skin in a sick premature newborn that is now rare because of improved neonatal care. The onset is characteristically after 24 hours of age. The skin feels hard and immobile and looks yellow and shiny. The trunk is always involved. Severely ill premature newborns that have suffered sepsis, hypoglycemia, metabolic acidosis, or other severe metabolic abnormalities are at risk. Biopsy sections show edema of fibrous septa surrounding fat lobules, but no fat necrosis. The etiology of this rare condition is unclear, and infant mortality is high.
Sclerema Neonatorum
Represents a failure of skin to fully develop, most often on the scalp, and less commonly elsewhere. It is often an isolated finding, but a multitude of associated conditions have been described. Some cases may represent a forme fruste of a neural tube defect. Is always hairless, and may appear vesicular, ulcerated, or covered by a thin epithelial membrane. When healed, lesions are usually atrophic scars, but sometimes develop a keloidal scar. Epidermis, dermis, and fat all may be missing, or a single layer may be absent.
Aplasia Cutis Congenita
A ring of darker and/or coarser terminal hairs on the scalp, typically surrounding ACC, dermoid cyst, encephalocele, meningocele, or heterotopic brain tissue. A marker of cranial dysraphism.
Hair Collar Sign
Iatrogenic anetoderma in extremely premature infants (born at 24–30 weeks’ gestation) with very low birthweight and prolonged neonatal intensive care hospitalization.
Anetoderma of Prematurity
Petechiae, purpura, jaundice, hepatomegaly, splenomegaly, microcephaly, encephalopathy, ocular abnormalities, anemia, thrombocytopenia, conjugated hyperbilirubinemia, or elevated serum hepatic transaminases
Congenital viral infection
Two or more lesions of any kind One lesion + spinal cord dysfunction Lipoma Tail Dermal sinus
High - Group 1: MRI indicated
Atypical sacral dimple (deep, farther than 2.5 cm from the anus, size ≥5 mm)
Unclassified hamartoma
Aplasia cutis congenita
Deviation of gluteal crease
Intermediate - Group 2: Ultrasound if younger than age 4 month (then MRI if ultrasound is abnormal), MRI indicated for age >4 month, or if sonographic expertise unavailable
Port-wine stain
Hypertrichosis (unless large and/or unusual)
Pigmented nevus
Simple sacral dimple (<5-mm diameter, 2.5 cm or closer to the anus)
Mongolian spot
Low - Group 3: No imaging needed
