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
Maximum dose of EMLA per age group
1 g for 1–3 month old
2 g for a 3–12 month old
10 g for a 1–6 year old
20 g was a 7–12 year old
A benign condition that occurs almost exclusively in female prepubertal girls. It appears as a pyramidal, soft-tissue, “tongue-like,” smooth, or velvety pink protrusion. It is usually located in the midline just anterior to the anus. This is usually asymptomatic, but painful defecation has been reported. It occurs in three settings: constitutional, functional (after constipation, diarrhea, or other irritant exposure), or associated with lichen sclerosus et atrophicus.
Infantile perineal protrusion
One of the most common dermatologic conditions in infants and children. The initiating factor is prolonged and increased wetness to the skin. This leads to increased frictional damage, decreased barrier function, and increased reactivity to irritants.
Diaper dermatitis
Most common type of diaper dermatitis. This dermatitis occurs in any person who wears diapers, regardless of age. It appears as erythematous, moist, and sometimes scaly patches on the convexities of the genitalia and buttocks, beginning in areas in closest contact with the diaper. Shallow erosions are sometimes present on the convex surfaces. It can be asymptomatic or tender.
Irritant Diaper Dermatitis
Second most common type of diaper dermatitis and presents with bright red erythematous, moist papules, patches, and plaques that tend to involve body folds as well as convex surfaces. Satellite lesions are very characteristic. Oral thrush can be associated.
Candida Diaper Dermatitis
Tends to occur at sites where plastic components of the diaper cause occlusion of eccrine ducts of the skin. It is also seen in the folds of the neck and upper torso, and is particularly common when there is a rapid shift to warm weather, and the child is overdressed.
Miliaria Rubra
Occur in the diaper and perianal areas in patients of any age with exposure to prolonged wetness. Children who wear diapers due to chronic urinary incontinence are prone to this type of dermatitis.
Pseudoverrucous Papules and Nodules
Represents an idiopathic form of retention keratosis in diaper-wearing infants. There are two clinical patterns: bilateral linear plaques in the inguinal folds and erythematous geometric plaques underlying pressure points from the diaper. A thick, flake-like scale is present in both forms and is characteristic. Spontaneous clearance after months to 1 year.
Infantile Granular Parakeratosis
An uncommon, severe diaper dermatitis that can occur at any age. It is characterized by welldemarcated, punched-out ulcers, or erosions with elevated borders. Prolonged contact with urine and feces under occlusion leads to this condition.
Jacquet Erosive Dermatitis
An uncommon condition characterized by reddish purplish nodules of different sizes (0.5–3.0 cm) occurring on the convexities of the diaper area in 2- to 9-month-old infants. It arises within preexisting diaper dermatitis. Biopsy shows dense dermal infiltrates of lymphocytes, plasma cells, neutrophils, and eosinophils, but no true granulomas.
Granuloma Gluteale Infantum
Refers to the typically reversible darkening of the linea alba, a hypopigmented linear patch extending from the pubis symphysis to the xiphoid process of the sternum
Linea nigra
A related finding comprising irregular, blotchy, facial hyperpigmentation that occurs in up to 70% of pregnant women. This tendency is aggravated by sun exposure and by oral contraceptive intake by nonpregnant women. It may regress postpartum, but oftentimes persists, posing a therapeutic challenge.
Melasma or chloasma
The most common structural change during pregnancy. Sites of predilection include the abdomen, hips, buttocks, and breasts. Genetic factors as family history, personal history, and race are the strongest predictors of an individual’s risk.
Striae distensae, also known as striae gravidarum or stretch marks
An intensely pruritic, vesiculobullous eruption of mid- to late pregnancy and the immediate postpartum period. It classically begins during the second or third trimester, and is manifest by the abrupt appearance of severely pruritic urticarial lesions on a background of normal or erythematous skin. It is associated with an increased incidence of small-for-gestational age births and premature delivery. This is immunologically mediated, and linear deposition of C3 with or without IgG are found at the dermal–epidermal junction by direct immunofluorescence (DIF).
Pemphigoid Gestationis
Characterized by a reversible form of cholestasis in late pregnancy. Patients classically present during the third trimester with moderate-to-severe pruritus, which may be either localized to the palms and soles or generalized. Intense pruritus is oftentimes associated with secondary excoriations, although primary cutaneous lesions are invariably absent. Progression to clinical jaundice, dark urine, or lightly colored stools occurs in approximately one in five patients.
Intrahepatic Cholestasis of Pregnancy
Hallmark of Intrahepatic Cholestasis of Pregnancy
Symptoms and associated biochemical abnormalities typically resolve within 2–4 weeks of delivery.
Single most sensitive indicator of Intrahepatic Cholestasis of Pregnancy
Elevation in serum bile acids
A naturally occurring hydrophilic bile acid, is the only treatment that has been shown to reduce maternal symptoms in Intrahepatic Cholestasis of Pregnancy and fetal risk.
Ursodeoxycholic acid (UDCA)
Characterized by an acute eruption occurring as early as the first, but generally during the third, trimester of an otherwise uneventful pregnancy. The condition manifests as erythematous patches whose margins are studded with subcorneal pustules. The eruption typically originates in flexural areas but spreads centrifugally and sometimes generalizes. Subungual lesions may result in onycholysis. The face, palms, and soles are commonly spared. The rash may be pruritic or painful. Onset of the eruption is accompanied by such constitutional symptoms as fever, chills, malaise, diarrhea, nausea, and arthralgias.
Pustular psoriasis of pregnancy or Impetigo herpetiformis
Most feared complications in Pustular psoriasis of pregnancy
Placental insufficiency and consequent stillbirth or neonatal death
A common benign intensely pruritic dermatosis that occurs almost exclusively in primigravidas during late pregnancy. Pathogenesis remains unknown. Polymorphous in nature, lesions may be urticarial (most commonly), vesicular, purpuric, polycyclic, targetoid, or eczematous in appearance. Typical lesions are 1- to 2-mm erythematous urticarial papules surrounded by a narrow pale halo. The eruption begins on the abdomen, classically within the striae gravidarum, and demonstrates periumbilical sparing. Pruritus generally parallels with the eruption and is localized to the involved skin. Rapid spread to the thighs, buttocks, breasts, and arms is the norm.
Pruritic urticarial papules and plaques of pregnancy
A benign pruritic condition of pregnancy characterized by an eczematous and/ or papular eruption in individuals with a personal and/or familial atopic background and/or elevated serum immunoglobulin E (IgE) levels. It comprises about 50% of all pregnancy dermatoses. This is thought to be triggered by pregnancy-related shifts in cytokine profile expression leading to preferential expression of T-helper 2 cytokines.
Atopic eruption of pregnancy
A process of progressive decreases in the maximal functioning and reserve capacity of all organs in the body, including the skin.
Aging
The terminal portions of eukaryotic chromosomes, consist of up to many hundreds of tandem short sequence repeats
Telomeres
Display some manifestations of aging at an accelerated rate but lack other features of normal aging and have characteristic findings that differ greatly from those of normal aging.
Premature aging syndromes
Two major roles of immune system
Defense against external insults
Internal immunologic surveillance
A universal, presumptively inevitable change attributable to the passage of time alone
Intrinsic aging
The superposition on intrinsic aging of changes attributable to chronic environmental insults, sun exposure, which are neither universal nor inevitable; also commonly termed photoaging, reflecting the large and well-studied role of chronic sun exposure.
Extrinsic aging
Histologic features of aging human skin: Epidermis
Flattened dermal–epidermal junction Variable/decreased thickness Variable cell size and shape Occasional nuclear atypia Fewer melanocytes Fewer Langerhans cells
Histologic features of aging human skin: Dermis
Atrophy (loss of dermal volume) Fewer fibroblasts Fewer mast cells Fewer blood vessels Shortened capillary loops Abnormal nerve endings
Histologic features of aging human skin: Appendages
Depigmented hair Loss of hair
Conversion of terminal to vellus hair
Abnormal nail plates
Fewer glands
The most striking and consistent histologic change in the epidermis
Flattening of the dermal–epidermal junction with effacement of both the dermal papillae and epidermal rete pegs
A population of cells responsible for epidermal maintenance
Epidermal stem cells
Prominent feature of photoaged skin characterized clinically by yellow discoloration and a sometimes pebbly surface and histologically by tangled masses of degraded elastic fibers that further deteriorate to form an amorphous mass composed of disorganized tropoelastin and fibrillin
Elastosis
Histopathology: Increased compaction of stratum corneum, increased thickness of granular cell layer, reduced epidermal thickness, reduced epidermal mucin content
Dryness (roughness)
Histopathology: Nuclear atypia, loss of orderly, progressive keratinocyte maturation; irregular epidermal hyperplasia and/or hypoplasia; occasional dermal inflammation
Actinic keratoses
Histopathology: Reduced or increased number of hypertrophic, strongly DOPApositive melanocytes
Freckling
Histopathology: Elongation of epidermal rete ridges; increase in number and melanization of melanocytes
Lentigines
Histopathology: Reduced number of atypical melanocytes
Guttate hypomelanosis
Histopathology: Increased number of DOPA-positive melanocytes and increased melanin content per unit area and increased number of dermal melanophages
Diffuse irreversible hyperpigmentation (bronzing)
Displays an increased number of hyperplastic fibroblasts as well as increased inflammatory cells, including mast cells, histiocytes, and other mononuclear cells
Heliodermatitis
Benign papules or plaques that are highly variable in size and color. They are considered by some as a biomarker of intrinsic aging. Represent clonal proliferations of both keratinocytes and melanocytes, presumably the result of focal epidermal homeostatic loss. No malignant potential.
Seborrheic keratoses
Dry, rough quality of skin that is almost universal in the elderly and may be attributed to a subtle disturbance of epidermal maturation, such as inadequate filaggrin production or altered lipid profile. Histologic studies reveal little alteration of either the viable epidermis or the stratum corneum with age.
Xerosis
A condition frequently found in the elderly during the wintertime, is dermatitis superimposed on xerosis. It is often caused by low humidity in a heated environment. It manifests by dry, fissured skin with fine scale and is usually localized to the pretibial region. This condition, which may be extremely pruritic, responds to application of medium-potency topical steroid ointments and/or liberal application of emollients.
Asteatotic eczema
The most common skin-related complaint of the elderly. In a majority of cases, attributable only to xerosis, often exacerbated by low humidity, frequent bathing, or application of irritants to the skin.
Pruritus
