ArticleLiterature Review

Newborn skin: Part I. Common rashes

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Abstract

Rashes are extremely common in newborns and can be a significant source of parental concern. Although most rashes are transient and benign, some require additional work-up. Erythema toxicum neonatorum, acne neonatorum, and transient neonatal pustular melanosis are transient vesiculopustular rashes that can be diagnosed clinically based on their distinctive appearances. Infants with unusual presentations or signs of systemic illness should be evaluated for Candida, viral, and bacterial infections. Milia and miliaria result from immaturity of skin structures. Miliaria rubra (also known as heat rash) usually improves after cooling measures are taken. Seborrheic dermatitis is extremely common and should be distinguished from atopic dermatitis. Parental reassurance and observation is usually sufficient, but tar-containing shampoo, topical ketoconazole, or mild topical steroids may be needed to treat severe or persistent cases.

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... Cutis marmorata-A common change in skin coloration noted by reticular mottling of the trunk and extremities, cutis marmorata can be present immediately after birth and may persist and remit throughout the first few weeks to months. 4 Skin changes occur due to physiologic venous and capillary dilation worsened by cooler environmental temperatures. 5 If dressing the baby warmly does not help resolve episodes cutis marmorata, evaluation for hypoglycemia or infectious etiology may be warranted. ...
... Harlequin color change-Affecting up to 10% of full-term newborns, harlequin color change occurs when a newborn is placed on his or her side, resulting in dependent erythema with contralateral pallor, persisting from 30 seconds to 20 minutes. 4 Although alarming in presentation, this benign vascular change may begin around days 2-5 of life and can persist up to 3 weeks. ...
... Erythema toxicum neonatorum-The most common skin condition in the newborn period, erythema toxicum neonatorum (newborn rash) affects roughly 40%-70% of all newborns. 4 This skin eruption may be present at birth but usually presents during the second or third day of life. Characteristics include 2-to 3-mm papules with surrounding erythema seen on the face and torso, described as a "flea-bite" rash. ...
Article
Newborn skin exhibits many changes within the first few weeks of life. The parents of newborns with skin conditions are often left concerned that something may be wrong. In this report we assess the many birthmarks, vascular changes, and rashes a neonate may exhibit with the aim of helping nurse practitioners to allay parental fears.
... Table 2: Frequency of skin disorders in normal birth weight and low birth weight DISCUSSION: Several studies report that skin changes in neonates are common. 1,3,4 For example, the frequency of cutaneous lesions in German neonates was 59.7% and in another study on neonates was 94.8%. 6,7 In our study 40.0% of the examined neonates had one or more skin disorder (excluding jaundice, cyanosis, spina bifida and scalp hematoma) The rate of birthmarks in our study was only 16.7%. ...
... The incidence of fungal skin infection in our study was greater than that observed in other studies where it ranged from 2% to 7%. 1,2,[5][6][7] Interestingly, it was more common in neonates with NBW than in LBW neonates. Besides, fungal skin infection was related to residence in a rural area (in 63% of fungal-infected neonates the mother resided in a rural area), but it had no relationship to maternal antibiotic therapy before delivery (in 68.4% of fungal-infected neonates the mother did not receive antibiotics before delivery). ...
Article
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The frequency of neonatal skin disorders has not been well studied in Rohilkhand region. In a descriptive prospective cohort study600 newborns from the SRMSIMS hospital nursery, they were dermatologically examined within the first 5 days of birth. Skin disorders were detected in 240 neonates (40.0%). Birthmarks were found in 100 neonates (16.7%), mainly melanocytic type (mongolian spots in 11.7% and congenital melanocytic naevi in 2.7%). Fungal skin infections, including oral moniliasis, fungal infection in the napkin area or candidal intertrigo, were detected in13.3% and bacterial infections in 1.3% of neonates. Comparisons with other studies worldwide indicated a higher rate of fungal infections and lower rate of birthmarks in our study. Routine neonatal dermatological evaluation is recommended, especially in view of the high rate of fungal skin infections. AIM’S AND OBJECTIVE: Our aim was to address patterns of dermatological changes in a sample of Indian newborns in Rohilkhand region.
... An incidence of 10% was observed for newborns in one investigation of neonatal cutaneous lesions from India [5]. Many factors including proliferation of the yeast Malassezia furfur (formerly Pityrosporum ovale), transplacental hormones and dysfunction of the sebaceous glands have been implicated in the pathogenesis of cradle cap, however, its exact etiology and pathogenesis are still unknown [2,6,7]. The distinction between cradle cap or infantile seborrheic dermatitis and other skin disorders such as atopic dermatitis and psoriasis can be difficult in infants. ...
... Whereas cradle cap is characterized by its early onset, mild and self-limited course, typical clinical picture, absence of itch and discomfort, atopic dermatitis is a chronic pruritic disease that may present as early as 3 months of age and due to severe itching and irritation can be extremely bothersome to the child. Psoriasis, on the other hand, is uncommon in this age group and is characterized by sharply demarcated erythematous lesions surmounted by a silvery scale [1,2,7,10]. ...
Article
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Introduction: Cradle cap is a very common condition in infants that presents as greasy, scaly patches on the scalp within the first weeks of life. Although usually disappearing by itself, the condition worries parents because of its appearance. When removing the scales, it is crucial to prevent spot bleedings to avoid infections. The investigational medical device LOYON(®) (Cetiol(®) CC, dimethicone) solution (G. Pohl-Boskamp GmbH & Co. KG, Hohenlockstedt, Germany) has the potential to meet these needs since it removes scales gently. It was, therefore, the aim of this proof-of-concept study to assess the efficacy and safety of topically applied, non-medicated LOYON(®) in facilitating the removal of scaling in infants and children with cradle cap without inducing spot bleedings. Methods: This single-center, open, proof-of-concept, pilot study was conducted in 20 male or female infants/children aged 3-36 months with clinically diagnosed cradle cap. The 8-day study period included one to three applications of LOYON(®). Clinical assessment of scaling and secondary parameters was performed at baseline and after treatment. Adverse events were recorded. A questionnaire on subjective efficacy and usability was handed out to the parents. Results: With a maximum of three applications of LOYON(®) applied to 20 subjects, a reduction in scaling intensity from moderate or severe to very mild or mild was achieved in 80% of the subjects. Treatment success, defined as the reduction of the scaling baseline score by at least two points, was achieved in 50% of subjects. Results of this study do not indicate any safety concern. No spot bleedings were observed. LOYON(®) was generally well tolerated and overall treatment was rated as "good" by the parents/legal guardians. Conclusion: This study suggests that LOYON(®) is well tolerated, safe and effective in facilitating the removal of scaling in infants and children with cradle cap. With its gentle approach and rapid effect, LOYON(®) thus represents a good alternative to home remedies for treatment of cradle cap.
... [4] A large number of changes from transient physiological to grossly pathological lesions are seen in the skin of a neonate. [5] The majority of the disorders in the newborn is physiological, transient, and self-limited and require no therapy. A working knowledge of both normal and abnormal cutaneous lesions of the neonates is required to determine, which skin lesion require early intervention. ...
... Fungal infections were observed in 4.5% of all cases; Oral candidiasis was seen in 4 of the studied neonates (3% of all cases), it was combined with monilial dermatitis; in similarity with previous studies [5,6,12] in which reported incidence was between 2% and 7%, respectively. Our results were similar to findings of Ferahbas et al. [15] who showed a significant association between candidiasis and maturity (more in preterm) and also was common in winter and autumn that were considered as a predisposing factor to such condition. ...
Article
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Objectives: The prevalence of cutaneous lesions in newborns varies among different sex, and race. There are limited reports of skin lesions among Egyptians neonates. This study was conducted to determine the prevalence of different cutaneous lesions in newborns and evaluates the association between age, gender, maturity, route of delivery, birth weight, maternal disease, and different skin lesion. Patients and Methods: All of the subjects were healthy newborn infants, who were born between April 2013 and March 2014. They were enrolled and examined for cutaneous lesions by pediatrician and dermatologists. All patients were examined within the first 7 days of birth. Results: A total of 177 neonates were included in this descriptive prospective cohort study. Skin disorders were found in 132 neonates out of 177 (74.6%) of cases and 45 (25.4%) of cases were free of any skin disorder. Benign transient lesions of newborn were the most common category of neonatal skin disorders that were seen in 54 neonates (41% of all cases), followed in frequency by birth marks that were noticed in 45 neonates (34% of all cases). Napkin dermatitis was considered the third common category of neonatal skin diseases 20 (15.2%). Genodermatoses were only noticed in 3% of cases. Other (6.8%) of cases were [epidermolysis bullosae (1.5%), cutis aplasia congenital (2.3%), histocytosis X (1.5%), Suckling blisters (1.5%)]. Conclusion: Benign transient lesions of the newborn were the most common category of neonatal skin disorders, followed in frequency by birth marks. The prevalence of different pathological skin lesion was not common. The prevalence of the skin lesions of newborns are different in this study, these could be due to environmental factors, race, the age of the infant and the period of observation of the studied subjects.
... Bacterial and viral cultures are negative. [11,12] In this index case, the diagnosis was based on history and examination findings and was supported with normal blood parameters and the absence of bacteria in culture secretions from the pustules. ...
... Treatment is therefore not necessary. [12] Our patient was treated as an outpatient without antibiotics. The parents were reassured and counseled on the benign nature of the rash. ...
Article
The presence of pustules or vesiculo-pustular lesions in newborns is always a cause of concern both to the family and the attending physician. Transient neonatal pustular melanosis (TNPM) is a benign idiopathic skin condition characterized by vesicles, superficial pustules, and pigmented macules, usually occurring in newborns at birth. It is self-limiting with spontaneous resolution. We report a case of TNPM in a term female who was managed without antibiotic administration and hospital admission.
... Milia are 1-2mm globular papules caused by retention of keratin within the dermis. 11 Higher incidence 24 (24%) of milia was noted in our study as compared to 8% and 6.8% in Behra et al. 5 and Gudurpenu et al. 7 ...
... Cutis marmorata is a reticulated mottling of the skin that symmetrically involves the trunk and extremities. 11 Cutis marmorata was noted in 2% of cases. Pandit et al. 4 and Gudurpenu et al. 7 noted in 1.3% and 2.7% of cases respectively. ...
Article
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Cutaneous problems in neonates have always been a significant part of paediatric dermatology. They range from physiological transient conditions at one end to serious pathological entities at the other. To study the clinical pattern of various dermatoses in neonates at a tertiary care centre. This is a hospital based cross-sectional observational study conducted at tertiary care centre. Total 100 neonates (≤ 28 days old) having any kind of cutaneous lesion were included in the study. Detailed history, clinical examination was done in all neonates followed by recording each finding and their statistical analysis. In the 100 neonates analysed, 53 were females (53%) and 47 (%) were males. 15 patients were born preterm, 78 in term and 7 in post term. Most of the skin lesions were asymptomatic but only 16 were having symptomatic skin lesion. Skin lesions in the study were physiological in 70%, pathological in 20% and mixed in 10%. Studying neonatal skin lesion is important to all dermatologists so that they are able to differentiate physiological and pathological conditions, thereby avoiding unnecessary therapy for neonates in circumstances not requiring any and also facilitating to allay undue anxiety among parents.
... e neonatal integumentary system offers physical protection, fluid balance regulation, immunosurveillance, and heat preservation, therefore playing a vital role in the newborn's transition from an aqueous to an air-dominant environment [1,2]. In this period, dermatological findings are prevalent and can differ significantly from physiological and selflimited lesions caused by the developmental process of the integumentary system to severe pathological issues, which requires interventions and collaboration between specialists [3]. erefore, early recognition is essential to differentiate benign lesions from more serious disorders and to provide proper counseling to parents. ...
... erefore, early recognition is essential to differentiate benign lesions from more serious disorders and to provide proper counseling to parents. Several fetal, maternal, and environmental factors, such as prematurity, congenital infections, ethnicity, and maternal drug use, can influence the onset, type, and evolution of cutaneous lesions [3][4][5][6]. Previous studies have been performed regarding cutaneous lesions in neonates and their association with fetal conditions and maternal factors, yet only a few of these studies were performed in a diverse population of Iran [7][8][9]. ...
Article
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Cutaneous lesions are common in the neonatal period and mostly physiological, transient, and self-limited; uncommonly, they are pathological and require treatment and cooperation between neonatologists and dermatologists. Particular conditions, like prematurity, can influence the onset, type, and evolution of cutaneous manifestations. Of the several articles in the literature about skin findings in newborns, only a few were performed in Iran. We aimed to investigate dermatological findings in a sample of neonates within the first three days of life and to evaluate the association between skin lesions and neonatal- or maternal-related variables. A total of 1202 newborns, hospitalized in the Department of Pediatrics of Imam Sajjad Hospital of Ramsar and Shahid Rajaee Hospital of Tonekabon, Iran, for two years, were examined. All skin findings were recorded, and information on neonatal and maternal variables was collected and analyzed to detect statistically significant associations. Skin lesions were present in 958 newborns (79.8%). The prevalence of milia, erythema toxicum, salmon patch, and Mongolian spots were 45.2%, 43%, 37.3%, and 37%, respectively. Natural vaginal delivery, use of medication, term gestation, and maternal disease were associated with a higher incidence of cutaneous lesions in neonates. Milia, erythema toxicum, Mongolian spots, and genital hyperpigmentation were seen more frequently in the male gender. Conversely, skin desquamation was seen more frequently in females. Among maternal diseases, gestational diabetes mellitus, urinary tract infection, preeclampsia, hypertension, psychiatric disorders, and uterine infection were associated with a higher prevalence of cutaneous lesions. Neonatal cutaneous lesions are a common source of concern in parents and inexperienced physicians. Therefore, prompt recognition of neonatal cutaneous lesions is essential in order to avoid unnecessary diagnostic and therapeutic procedures.
... To exclude neonatal pustulosis, it is of prime importance to first look for an infectious etiology such as congenital candidosis, bacterial pustulosis (Staphylococcus aureus, Streptococcus B, Haemophilus influenzae, Pseudomonas aeruginosa, Listeria monocytogenes), congenital syphilis, a viral infection (herpes, varicella, cytomegalo virus) or scabies [7,8] . In this case, samples for bacterial (cutaneo-mucosal, blood cultures), mycological, viral and parasitologic tests as well as skin biopsies must be systematically done [9] . ...
... In this case, samples for bacterial (cutaneo-mucosal, blood cultures), mycological, viral and parasitologic tests as well as skin biopsies must be systematically done [9] . The other transitory noninfectious neonatal pustular dermatosis like military pustulosis, neonatal acne and infantile acro-pustulosis have to be equally discussed taking into consideration the clinical context [6][7][8]10] . ...
... SD of the Scalp and Hairy Areas SD management in infants involves advising simple measures, such as regular washing of the scalp with baby shampoo and gentle brushing to loosen scales [62] . The daily use of white petrolatum may help to soften scales. ...
... The daily use of white petrolatum may help to soften scales. If these measures are not effective, ketoconazole 2% shampoo could be used until the condition resolves [62,63] (category A, level 1b) . The clinical efficacy of AIAFp cream in infants has been demonstrated in a multicentre, Color version available online double-blind, placebo-controlled, parallel-group study in infants with cradle cap, in whom there was a significant difference in the reduction of scaling between the treatment and placebo groups [64] . ...
Article
Seborrhoeic dermatitis (SD) is common in Asia. Its prevalence is estimated to be 1-5% in adults. However, larger population-based studies into the epidemiology of SD in Asia are lacking, and the aetiology of SD may differ widely from Western countries and in different parts of Asia. In addition, clinically significant differences between Asian and Caucasian skin have been reported. There is a need to define standardized clinical diagnostic criteria and/or a grading system to help determine appropriate treatments for SD within Asia. With this in mind, experts from India, South Korea, Taiwan, Malaysia, Vietnam, Singapore, Thailand, the Philippines, Indonesia, and Italy convened to define the landscape of SD in Asia at a meeting held in Singapore. The consensus group developed a comprehensive algorithm to aid clinicians to recommend appropriate treatment of SD in both adults and children. In most cases, satisfactory therapeutic results can be accomplished with topical antifungal agents or topical corticosteroids. Non-steroidal anti-inflammatory agents with antifungal properties have been shown to be a viable option for both acute and maintenance therapy.
... Many changes from transient physiological to grossly pathological lesions are seen in the skin of a neonate [12], [21]. The majority of the disorders in the newborn are physiological, transient, and self-limited and require no therapy. ...
... The newborn or neonatal period generally describes the first four weeks postnatal period (1), whereas infancy is the first year of life (2). Cutaneous manifestations are commonly detected in neonatal period and with variety of presentations in a wide geographic areas and ethnic groups (2,3). Many studies have been performed in different countries to determine the prevalence of neonatal skin lesions across various racial groups. ...
Article
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Background: Cutaneous manifestations are commonly observed in the neonatal period. It is important to differentiate physiologic skin lesions from pathologic ones to avoid parents’ concerns. Regarding this, the current study aimed to investigate the frequency and localization of salmon patch (SP) and Mongolian spot (MS) in Iranian newborns to assess the potential relationship between the neonatal and maternal characteristics. Methods: This descriptive cross-sectional study was conducted on one thousand healthy infants born at Al-Zahra University Hospital in the northwest of Iran during August-September 2014. For the aims of the study, the neonates were examined by a pediatrician. The collected data included gender, gestational age, anatomical sites of the lesions (MS and SP), birth weight of the newborns, parental consanguinity, parity, and maternal age. The exclusion criteria included major known congenital chromosomal or metabolic abnormalities, stillbirths, and admission in the Sick Newborn Care Unit or Neonatal Intensive Care Unit. Results: According to the results of this study, the frequency rates of MS and SP among 1000 newborns were found to be 32.3% and 14.5%, respectively. Maternal age was the only variable which showed a statistically significant relationship with SP (P=0.024). In addition, sacral region and upper eyelid were found to be the most common site of MS and SP involvement, respectively. Conclusion: MS and SP which are commonly observed in the routine neonatal examination may worry parents regardless of their association with an underlying systemic disorder. Regarding this, we recommend careful examination of the newborns’ skin by pediatrician in the neonatal wards.
... In conventional medicine, erythema toxicum neonatorum, acne neonatorum, transient neonatal pustular melanosis, seborrheic/atopic dermatitis, milia, and miliaria have been clinically diagnosed and characterized. Bacteria, fungi, and viruses are implicated as the causal organisms (O'Connor, 2008). All these technical terms are known as skin rashes by the unlettered nursing mothers in rural and semi-urban areas or as skin inflammations manifesting as swelling, redness, itching, heat, and pain (Ikeda et al., 2008). ...
Article
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Background: The period of infancy, spanning through the neonatal stage to two years, is characterized by a series of health challenges for the affected child and concerned parents. This study conducted in Odeda Local Government Area of Ogun State, Nigeria was aimed at investigating the plants used in the traditional management of infantile dermatitis and other neonatal skin infections with emphasis on the role of SPICES.Methods: Structured questionnaires (and personal interview) were administered to 36 nursing mothers (age range, 15 – 50) and 30 herbsellers (age range, 21 – 60) in the LGA. The herbsellers prescribed recipes used in the management of general skin diseases including abscess, chicken pox, eczema, flaky skin spots, measles, rashes, ringworm, and small pox.Results: The survey yielded 69 plants belonging to 38 families and forming 25 polyherbal and mono-recipes. Fabaceae, Rutaceae, Euphorbiaceae, Annonaceae, Poaceae, Meliaceae, and Amaryllidaceae had high species representation. Trees (40.58%) were the most frequently used plant habit while leaves (40.58%) formed the most frequently used plant part. Decoction and infusion using pure water were the methods of preparation suggested. Administration ranged from drinking extracts (2-3 teaspoonfuls) three times daily, to bathing with warm extracts of the plants and the use of coconut oil as cream. Traditional black soap and Shea butter also featured in the herbal remedy for bath and as cream respectively. Local sponge was preferred for bathing.Conclusion: This study has documented the alternative medical approach in the management of infantile skin diseases. The cultural relevance of plants calls for sustainable use of plant resources. This research finds application in primary health care, microbiology, and in cosmetic industries for the development of new or improved baby skin care products. Further research should be conducted to confirm the claimed ethnomedicinal values as well as evaluate possible harm of crude plant extracts to skin structures of infants.
... The newborn or neonatal period generally describes the first four weeks postnatal period (1), whereas infancy is the first year of life (2). Cutaneous manifestations are commonly detected in neonatal period and with variety of presentations in a wide geographic areas and ethnic groups (2,3). Many studies have been performed in different countries to determine the prevalence of neonatal skin lesions across various racial groups. ...
... Yenidoğanın fizyolojik özellikleri iyi bilinirse geçici, benign, tedavi gerektirmeyen dermatozlarla; tedavi edilmesi gerekli ciddi hastalıkların ayrımı ile konjenital hastalıkların erken tanı ve tedavisi yapılabilir (4) . ...
... In some cases infantile acne may be more persistent and even cause scarring, so a treatment must be administered. Papules and pustules respond well to topical benzoyl peroxide or erythromycin or topical tretinoin in low concentrations (0.01% gel or 0.025% cream) (2,4,5). ...
Article
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... Port-wine stains (PWS) are one of the vascular birthmarks and also known as nevus flammeus 1 . PWS occur in 0.3 percent of the live newborns, affecting females and males equally in different racial ethnicities [1][2][3][4][5][6] . ...
Article
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Nevus flammeus, which is also known as port-wine stain (PWS), is one of the vascular birthmarks. PWS occurs in 0.3% of the newborns in both genders. It is a capillary vascular malformation, characterized by a pink or red stain and may involve skin, soft tissue and/or bone. There are a very limited number of reports regarding intraoral involvement of PWS. We report 2 female patients with PWS from date of birth. The first patient was an 11-year-old female who applied to our clinics for the treatment of her non-aesthetic and deviated intraoral view and discoloration of her gingiva, and the second patient was a 56-year-old female who applied for the extraction of her wisdom tooth. Extraoral examination in both patients revealed a diffuse PWS on the right side of their face over the cheek, extending from the midline. While the first patient had reddish skin, gingiva on right site her both jaws and lips, the second patient had only her upper jaw and lip. Because of the first patient’ age, the treatment postponed to her 20’, and the second patient did not accept any treatment. PWS is a rare and non-fatal condition; however, the unique appearance of these patients can lead to psychological problems especially in early ages.
... The condition typically affects areas rich in sebaceous glands such as the scalp, eyebrows, glabella, nasolabial folds, postauricular area, and intertriginous areas [2,3]. In general, scaling tends to predominate on the scalp whereas erythema tends to predominate in the flexural folds and intertriginous areas [4]. ...
... Cutis marmorata is cutaneous vascular finding that can be found in almost 10% of newborns [1]. The most common form, also known as reticular mottling of the skin, is transient and benign [2] . The exaggerated vasomotor response to hypothermia and immaturity of the autonomic nervous system are suggested underlying mechanisms. ...
... Open comedones, inflammatory papules, and pustules can also develop. A treatment is not especially recommended, but infants can be treated with a 2.5% benzoyl peroxide lotion if lesions are extensive and persist for several months (20). Severe neonatal acne accompanied by other signs of hyperan-drogenism should prompt an investigation for adrenal cortical hyperplasia, virilizing tumors. ...
Article
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The newborn skin can be separated from adult's skin in several ways. In dermatologic examination it can be easily observed that it is thinner, less hairy and has less sweat and sebaceous gland secretions. These differentiations present especially in preterm newborns. Their skin is exposed to mechanical trauma, bacteria and weather, heat alterations. At birth, newborn skin is protected by the coverage of vernix caseosa, which has lubricating and antibacterial features and its pH ranges from 6.7 to 7.4. Beneath the vernix caseosa the skin has a pH of 5.5-6.0. In newborn dermatologic examination it is very important to distinguish transient benign dermatoses and severe diseases, make early diagnosis and treat congenital skin disorders. Although the benign cases are common in this life period, clinical presentations can be much more exaggerated, dramatic and cause a great deal of anxiety to parents. Therefore, as a doctor, knowing the dermatological, pathological and non-pathological common skin rashes guides the family in the right direction, offers advice to reduce uncertainty and time for the treatment of severe conditions and builds a confidential doctor-patient relationship. In this review, our aim is to provide a general overview to common skin rashes in newborn period.
... Some may resolve over time. [8][9][10] Head and Neck The shape of the head can be an indicator of potential abnormalities. As the brain expands, the shape of the head may be characterized by marked asymmetry, which could suggest possible craniosyntosis. ...
... Unlike erythema ab igne, there is no hyperpigmentation and tends to be more diffuse. 10 When evaluating a reticular rash, consider local and systemic etiologies. If more localized and hyperpigmented, ask about heat or infrared exposure. ...
Article
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A man presented with a nontender, flat rash with pigmentary alteration ranging from light brown to dark brown on his left leg. How would you treat this patient?
... This is often seen in areas of friction from skin rubbing against skin or clothing. 15 It is usually self-limiting. Treatment is supportive and includes wearing light, loose garments and avoiding overheating. ...
... They differ from adult in immaturity of collagen, hair follicle and sebaceous glands. 2 A host of aberrations varying from physiological and transient to grossly pathological are seen in the skin of a neonate. The spectrum of dermatological manifestations in neonates varies from era to era and country to country. ...
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p class="abstract"> Background: The spectrum of dermatological manifestations in neonates varies from era to era and country to country. Skin lesions in neonatal period vary from transient self-limiting conditions to serious dermatoses, requiring specific therapies. Skin lesions are extremely common in newborns and can be a significant source of parental concern. The objective of the study was to study various mucocutaneous lesions in newborn babies. Methods: The present descriptive cross sectional observational study was conducted in department of dermatology, Navodaya Medical College, Raichur. A total 500 neonates were included in the study from January 2012 to September 2013. Data collected and analysed by using SPSS 16.0 version. Results: Prevalence of skin lesions in this study was found to be 97.4%. Maximum skin lesions were observed in 47 subjects (9.4%). Prevalence of Epstein pearls was 58%, Mongolian spots 53.6% and erythema toxicum neonatorum was 28%. Epstein pearls (males 60.2%, female 55.7%) and Mongolian spots (males 53.9%, females 53.3%) predominated. Conclusions: Prevalence of mucocutaneous skin lesions in newborn babies was 97.4%. High prevalence of Epstein pearls (58%), Mongolian spots (53.6%) and erythema toxicum neonatorum (28.6%) were observed.</p
... After birth, baby's skin is vulnerable to develop a variety of physiological and pathological lesions such as transient lesions, napkin dermatitis and related disorders, infective lesions, blisters, and birthmarks [4]. Neonatal dermatological conditions vary widely from transient physiological to grossly pathological ones [5]. Majority of neonatal skin lesions being physiological, transient, and self-limiting need only reassurance in contrast to a few needing interventions [6,7]. ...
Article
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S kin is the largest external organ of the body which protects the internal organs, serves as anatomical barrier to infection, contributes to thermoregulation, contains insulating fats, excretes electrolytes, and provides tactile sensory inputs [1]. In contrast to adults, the neonatal skin is thinner, delicate, has weaker intercellular attachments, and produces fewer sweat and sebaceous secretions, and above all is more susceptible to infections [2]. Coated with vernix caseosa, neonatal skin has antimicrobial properties which confers protection both intrauterine and postnatal [3]. In utero, baby's skin is well protected by amniotic fluid. After birth, baby's skin is vulnerable to develop a variety of physiological and pathological lesions such as transient lesions, napkin dermatitis and related disorders, infective lesions, blisters, and birthmarks [4]. Neonatal dermatological conditions vary widely from transient physiological to grossly pathological ones [5]. Majority of neonatal skin lesions being physiological, transient, and self-limiting need only reassurance in contrast to a few needing interventions [6,7]. However, due to poor knowledge and diagnostic dilemma, many benign healthy neonates get treated by many ointments and powders by local doctors, some pediatricians, and some dermatologists [8]. These types of therapy do more harm to delicate neonatal skin. The objective of this study was to find the prevalence and clinico epidemiological profile of skin conditions of healthy neonates which will help to differentiate the treatable and untreatable conditions of neonates. This study will help common people not to get panic in case of sporadic skin lesions in a healthy neonate. ABSTRACT Background: Skin lesions are much common and specific to neonates. They vary according to age, sex, and geographic region. Objectives: The objective of this study was to determine the prevalence of different cutaneous lesions in newborns and their association with the type of delivery, age, sex, and maturity. Materials and Methods: This study was done in neonatal follow-up clinic of department of Pediatrics, Maharaja Krushna Chandra Gajapati Medical College, Berhampur, Odisha. All the healthy newborns coming to the OPD from January 2015 to December 2016 were included in this prospective study, and their details were recorded in case recording format after taking informed consent from their guardians. Admitted patients were excluded from the study. Statistical assessments were the done by SPSS software. Results: Out of 500 neonates, skin lesions were found in 366 (73.2%) patients. Physiological cutaneous lesions were most common, consisting 259 (70.7%) neonates. Out of the physiological lesions, benign transient lesions were seen in 163 (44.6%), out of which 95 (25.9%) had papulopustular dermatoses followed by erythema toxicum in 48 (13.1%) cases. Birthmarks were seen in 138 (37.8%) cases; pigmentary birthmarks 89 (24.5%) being the most common birthmarks followed by Mongolian spots in 71 (19.4%) cases. Pathological lesions were seen in 107 (29.3%) cases, of which nappy rash was detected in 65 (18.01%) cases. Term and male babies had a higher incidence of skin lesions. Conclusion: Benign lesions are the most common group of neonatal cutaneous manifestations which is followed by birthmarks. Conditions such as nappy rash and contact dermatitis are common pathological lesions and majority of them are preventable. Differentiation of the physiologic skin lesions from the pathologic ones is essential to avoid unnecessary therapeutic interventions.
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A prevalence survey of pigmented and vascular birthmarks in 1000 newborns from the Northeast of Iran Background: Birthmarks are common reasons for parents' concern. Some of them may need further investigation to find out the underlying systemic disorders or their potential for malignant transformation. The purpose of this study was to determine the frequency of vascular and pigmented birthmarks in infants from the Northeast of Iran. Method: This descriptive study was conducted on 1000 healthy infants born in a University Hospital in the Northeast of Iran from 2003 to 2005. The cutaneous lesions of neonates were examined by a dermatologist. Result: The salmon patch was reported as the most common birthmark (233 cases). The most common site of involvement was the eyelid. A case of congenital hemangioma and a case of the port-wine stain were also observed both in the fifth nerve path. The most common pigmented birthmark was the Mongolian spot (171 cases). The congenital melanocytic nevus was seen in 50 cases. The lumbosacral area and trunk were reported as the most common sites of involvement for the Mongolian spot and congenital melanocytic nevus, respectively. Conclusion: Fortunately, the most common birthmark is the salmon patch that is evanescent. The congenital melanocytic nevus had a relatively high prevalence rate (5%) in comparison with other studies. Since the appearance of these lesions can concern parents and there is an increased risk of melanoma in the cases of congenital melanocytic nevi, follow up is needed in some cases; we recommend careful examination of the infant's skin and training of physicians working in neonatal wards.
Article
Unlabelled: A newborn's skin may exhibit a variety of changes during the first weeks of life, and rashes are extremely common in the neonatal period, representing a significant source of parental concern. In particular, a variety of skin eruptions can present as pustules. Most of them are innocuous and self-limiting, while others can be the manifestation of an infectious disease or even indicative of serious underlying disorders. Transient neonatal pustular melanosis is an uncommon vesiculopustular rash characterized by small pustules on a non-erythematous base, noted at birth or during the first day of life, without systemic symptoms. The lesions rupture spontaneously, leaving hyperpigmented macules that usually fade within few weeks. Clinical recognition of this disease can help physicians avoid unnecessary diagnostic testing and treatment for infectious etiologies because no specific therapy is recommended. The clinical aspect and time of onset are generally sufficient to make the correct diagnosis. Nevertheless, peculiar clinical presentations may require additional work-up to rule out life-threatening conditions, and dermatological consultation and histological examination are required for the final diagnosis. Conclusion: We report an exceedingly unusual presentation of transient neonatal pustular melanosis, suggesting the importance of a systematic diagnostic approach to allow a confident recognition of this benign condition.
Article
Acne may present in neonates, infants, and small children. Neonatal and infantile acne vulgaris are not considered to be rare. The presentation of acne in this patient population sometimes represents virilization and may portend later development of severe adolescent acne. Neonatal and infantile acne vulgaris must be distinguished from other cutaneous disorders seen in newborns and infants. Infantile acne tends to be more pleomorphic and inflammatory, thus requiring more vigorous therapy than neonatal acne.
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This chapter is an overview of common and uncommon dermatological diseases with emphasis on presentations in the neonatal period. Whenever possible, differential diagnoses based on morphological presentation were offered.
Article
Skin findings are common during the newborn examination. Although these findings are often benign, it is important to visualize the entire skin surface to distinguish these findings and appropriately reassure parents. The chest should be observed for symmetric movement, pectus excavatum, pectus carinatum, prominent xiphoid, or breast tissue. The infant should be as relaxed as possible so that the physician can more easily detect any abdominal masses, which are often renal in origin. A single umbilical artery may be associated with another congenital abnormality, especially renal anomalies, and intrauterine growth restriction and prematurity. Signs of ambiguous genitalia include clitoromegaly and fused labia in girls, and bilateral undescended testes, a micropenis, or a bifid scrotum in boys. Sacral dimples do not warrant further evaluation if they are less than 0.5 cm in diameter, are located within 2.5 cm of the anal verge, and are not associated with cutaneous markers; dimples that do not fit these criteria require ultrasonography to evaluate for spinal dysraphism. Brachial plexus injuries are most common in newborns who are large for gestational age, and physical therapy may be required to achieve normal function. Patients with abnormal findings on Ortolani and Barlow maneuvers should be evaluated further for hip dysplasia. It is also important to assess newborns for tone and confirm the presence of normal primitive reflexes.
Article
The neonatal period is regarded as the first four weeks of extrauterine life. Skin disorders are commonly seen in the neonatal period, most of which are transient benign conditions such as physiologic desquamation, erythema toxicum neonatorum, milia, miliaria and colour changes. However, rare and serious infections, genetic diseases and tumours can be seen in this period. Differential diagnosis of benign transient skin conditions and serious disorders are very important. Environemental and genetic factors may regulate skin manifestations in newborn. (Turkderm 2011; 45 Suppl 2: 68-72)
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Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.
Article
The major functions of the human skin are maintenance of water and electrolyte homeostasis, thermoregulation, antimicrobial defense, protection from trauma, environmental toxins and ultraviolet radiation, synthesis of vitamin, immune surveillance; it is important from an esthetic point of view, serves as a sensory organ and facilitates mother-child attachment. The skin of the newborn differs from that of an adult in several ways. Newborn skin care is mandatory to avoid skin infections. As a result of normal daily exposure to these external factors, good skin hygiene, proper skin cleansing and protection of the infant skin barrier are essential to maintain the barrier function and overall health. The aim of this work is to assess the neonatal skin care effectiveness in promotion of normal skin development and protection of the optimal skin function to prevent the different neonatal skin disorders.
Article
Introduction Dermal melanocytosis Transient neonatal pustular melanosis Acropustulosis of infancy Kawasaki's disease Childhood-onset systemic lupus erythematosus and cutaneous lupus erythematosus Neonatal lupus erythematosus Traction folliculits/alopecia Tinea capitis Atopic dermatitis Ichthyosis Keratosis pilaris Lichen striatus Epidermal nevus Phytophotodermatitis Recognizing jaundice Measles Vascular lesions Childhood granulomatus periorificial dermatitis Neurofibromatosis type 1 Molluscum contagiosum Seborrheic dermatitis Acquired acrodermatitis enteropathica References
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You report to the emergency department to admit a hypoxemic, 2-month-old boy with respiratory syncytial virus (RSV) bronchiolitis. He has been growing well and has no other significant past medical history. As you're listening to his wheezing chest, his mother asks about the big freckles on his scalp and forehead that have been present since birth.
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Infant patients are a unique challenge to emergency department (ED) physicians as the spectrum of normal infant signs, symptoms and behaviors are often difficult to differentiate from abnormal and potentially life-threatening conditions. In this article, we address some common chief complaints of neonates and young infants presenting to the ED, and contrast reassuring neonatal and young infant signs and symptoms against those that need further workup and intervention.
Article
Dermatology is a visual specialty, and an accurate description of a “rash” makes it more likely that the practitioner will be able to classify a particular eruption and rapidly arrive at the right diagnosis. This chapter begins with definitions of dermatologic terms, which when used in conjunction with Table 5-1 can serve as a guide to the most common diagnoses. Definition of terms Primary lesions Macule A flat, non-palpable, superficial skin color change that is <1 cm in diameter. A macule can be red, brown, yellow, or white. Patch A macule that is >1 cm in diameter. Papule A firm, palpable, elevated lesion that is <1 cm in diameter. A papule may be flat-topped, dome-shaped, or pointed. Plaque A papule that is >1 cm in lateral diameter. It is a broad, elevated, flat-topped solid lesion often formed by a confluence of several papules. In contrast to a nodule, it does not possess increased depth, and is a “plateau,” rather than a “glacier.” Nodule A papule that is enlarged in all three dimensions: length, width, and depth. It may be dome-shaped or slope-shouldered, but the discriminating characteristic is increased depth compared to a papule or plaque. Tumor A large nodule. Wheal An evanescent, edematous, smooth, raised, pink to red lesion. The classic description is “hive-like.” Vesicle A sharply circumscribed, elevated, clear fluid-filled lesion that is <1 cm in diameter. A vesicle is often thin-walled and fragile, so it ruptures easily. Therefore, patients may present instead with small erosions (de-roofed vesicles).
Article
Introduction: Taking care of newborn skin is necessary to avoid skin infections. The normal daily exposure to external factors affects the skin negatively. Skin hygiene and proper skin cleansing as well as protection of the infant skin barrier are essential to maintain barrier function and overall infant health. Aim: The aim of this work is to assess the neonatal skin care effectiveness in promotion of normal skin development and protection of the optimal skin function by avoiding the different neonatal skin disorders which cause skin infection. Conclusion: In conclusion, proper care and good hygiene of the normal mature neonatal skin are essential to maintain skin barrier function and overall health. This is achieved by optimizing epidermal barrier integrity that includes: bathing and using emollient; preventing and managing infections and skin injury; minimizing transepidermal water loss (TEWL); minimizing heat loss and percutaneous absorption of toxins. Baby bath products as well as baby wipes are safe to use and do not appear to affect an infant's skin barrier integrity. It is therefore sensible to use cleansers that have been specially designed for baby's skin, which are pH neutral and very mild to avoid irritant dermatitis and allergic dermatitis.
Article
Skin has an important role as a barrier against transepidermal water loss, mechanical trauma, UV radiation, allergens, microorganisms and penetration of irritating substances. Taking part in homeostasis, it plays one of the fundamental roles in adaptation to life. In newborn skin there are some anatomical and physiological differences, caused by skin immaturity, which are especially significant in premature and neonate children. These differences related to the skin include greater body surface area to volume ratio, thinner and more permeable stratum corneum, lower activity of sebaceous and sweat glands, and skin pH closer to neutral value. It causes normal barrier function disruption, skin permeability augmentation and immaturity of the thermoregulatory mechanisms. It can also induce skin hypersensitivity, higher prevalence of irritation and allergic reactions, which is why proper care and protection is so significant. Skin care practices should take into account anatomical dissimilarities and cosmetic products should be adjusted to age and skin condition. After a thorough examination pathologically changed skin needs individual treatment. This review article presents anatomical and physiological differences in the infant's skin. Skin care practices for healthy and pathologically changed skin are also discussed.
Article
It is reviewed the most common cutaneous disorders in newborns and infants. The benign transitory lesions of newborn include the erythema toxicum neonatorum, neonatal pustular melanosis, neonatal acne and miliaria. The skin of newborn have special characteristics that are discussed. The birthmarks can be vascular (malformations or angiomas) and pigmented (melanocytic lesions, melanocytic nevi and mosaicisms) The hemangiomas are classified in superficial and deep.Their importance is based on the size or location. Diaper rash or diaper dermatitis is a multicausal disease that can be prevent with higienic practices. The most frequent complication is the superinfection of Candida albicans.
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Seborrheic dermatitis (SD) is a chronic relapsing erythematous scaly disease with a prevalence of 1–3% in the general population. The exact etiology is unknown and multifactorial; the most accepted theory suggests that yeast of Malassezia spp. causes skin irritation and inflammation on the seborrheic areas in susceptible individuals. The clinical diagnosis is based on the location and appearance of the lesions. Treatment objective is to clear the signs of the disease, ameliorate the symptoms, and maintain remission with long-term therapy. Topical antifungal and anti-inflammatory agents are the first-line therapy. Systemic therapy is reserved only for severe or refractory cases, and alternative therapies have also been reported.
Article
Full-text available
Neonatology represents one of the subspecialties of pediatrics and there are skin conditions in the neonatal period, which need prompt recognition by both neonatologists and pediatric dermatologists. Premature skin immaturity in the neonatal period is associated with transient benign dermatoses; birthmarks some of which may require further work-up for underlying defects or malignant potential may cause considerable confusion in the neonatal period. This article focuses on proper diagnoses of these dermatoses and birthmarks in order to reassure the parents and initiate further evaluation if there are risks for complications or malignant transformation.
Chapter
Transient neonatal pustular melanosis (TNPM), an idiopathic dermatitis largely observed in full-term neonates with skin of color, has distinctive features characterized by small vesicles and pustules that rupture easily, leaving collarettes of scaling and hyperpigmented macules. Although clinical presentation or stage may vary, the lesions of TNPM are distinctively present at birth and may manifest anywhere on the body, including the palms of the hands and soles of the feet. The initial lesions usually disappear spontaneously within the first 2 weeks of life without long-term sequelae, and no treatment is required.
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Article
Recent focus on the neonatal intestinal microbiome has advanced our knowledge of the complex interplay between the intestinal barrier, the developing immune system, and commensal and pathogenic organisms. Despite the parallel role of the infant skin in serving as both a barrier and an interface for priming the immune system, large gaps exist in our understanding of the infantile cutaneous microbiome. The skin microbiome changes and matures throughout infancy, becoming more diverse and developing the site specificity known to exist in adults. Delivery method initially determines the composition of the cutaneous microbiome, though this impact appears transient. Cutaneous microbes play a critical role in immune system development, particularly during the neonatal period, and microbes and immune cells have closely intertwined, reciprocal effects. The unique structure of newborn skin influences cutaneous microbial colonization and the development of dermatologic pathology. The development of the infantile skin barrier and cutaneous microbiome contributes to future skin pathology. Atopic dermatitis flares and seborrheic dermatitis have been linked to dysbiosis, while erythema toxicum neonatorum is an immune response to the establishment of normal bacterial skin flora. Physicians who care for infants should be aware of the impact of the infantile skin microbiome and its role in the development of pathology. A better understanding of the origin and evolution of the skin microbiome will lead to more effective prevention and treatment of pediatric skin disease.
Article
La mélanose pustuleuse transitoire est une dermatose néonatale relativement fréquente, bénigne, souvent méconnue. Son diagnostic est clinique, caractérisé par la survenue précoce d’une éruption vésiculopustuleuse étendue, évoluant rapidement vers de petites macules pigmentées. L’évolution est spontanément favorable en quelques semaines, ce qui permet de différentier cette pustulose des autres dermatoses pustuleuses néonatales notamment d’origine infectieuse. Nous rapportons une observation de mélanose pustuleuse transitoire et discutons les problèmes nosologiques et les principaux diagnostics différentiels de cette entité.
TOXIC erythema is a benign self-limited dermatitis occurring in newborn infants within the first days of life. The condition was first mentioned by Bartholomaeus Metlinger in 14721 and named erythema toxicum neonatorum by Leiner2 in 1912. It consists of erythematous macular lesions followed by papulovesicular lesions pustules. The etiology of this condition still remains unclear.It is generally agreed that the incidence of toxic erythema is lower in premature infants than in term infants.3,4 This study was undertaken to determine the relation of three parameters of infant maturity to the development of toxic erythem.Materials and Methods A surveillance was made of two term nurseries with an approximate daily population of 25 each and the premature center with an average daily census of 75. All infants less than 12 hours of age when first seen were included in the study and examined daily until their discharge. Term
Article
We describe a 10-day-old term infant who presented to the emergency room with an acute pustular eruption. Laboratory tests and clinical outcome confirmed the diagnosis of erythema toxicum neonatorum. A full septic workup was performed and all cultures were negative. Wright-stained smear of pustular contents showed a predominance of neutrophils with 10% eosinophils. The white blood cell count was 19,000/mm3 with 10% eosinophils. The eruption resolved spontaneously at 15 days of age leaving no sequelae. This is the first fully documented case of erythema toxicum in a term infant occurring as late as 10 days of age. When erythema toxicum presents in an atypical fashion, diagnostic tests are important to exclude other causes of pustular dermatoses of the neonate.
Article
Background Acne is not uncommon in the neonatal period. Acne neonatorum is characterized by a mainly facial eruption of inflammatory and noninflammatory lesions. It is most commonly mild and transient. Hyperactivity of sebaceous glands, stimulated by neonatal androgens, has been implicated as the underlying pathogenetic mechanism. Materials and methods All patients diagnosed with acne neonatorum in “A. Sygros” Hospital, Athens, Greece, during the years 1993–1996, were evaluated clinically and epidemiologically. Histologic examination and smears for Propionibacterium acnes and Pityrosporum ovale were performed in selected cases. Results Of the 22 patients studied, 18 were male (81.8%) and 4 were female. The mean age at onset was 3 weeks and the mean duration of the disease was 4 months. Papules and pustules were the most frequent types of lesions (72.7%), followed by comedones only (22.7%). The cheeks were the most common site of predilection (81.8%). A family history of acne was reported in only three patients. Histologic examination showed hyperplastic sebaceous glands with keratin-plugged orifices. Smears for P. ovale were negative. Conclusions Our findings are consistent with previous experience, although inflammatory lesions were encountered more often than previously reported. Hereditary factors did not seem to play a significant role in our series. Topical treatment hastened the resolution of this self-limited condition. Recalcitrant cases warrant investigation for underlying androgen excess.
Article
MACULAR erythema developed on one half of the body of a full-term new-born with transient tachypnea on the third day of life (Figure 1). The color change lasted 10 minutes and was not associated with changes in vital signs. A similar change in body color developed in an otherwise healthy premature infant on the fifth postnatal day (Figure 2). Denouement and Discussion Harlequin Color Change The harlequin color change was first described by Neligan and Strang in 1952.1 Premature infants are more commonly affected than fullterm infants, but up to 10% of full-term infants may display this phenomenon, most commonly on the third or fourth days of life.2,3 The characteristic appearance is a macular erythema involving one half of the infant's body, with simultaneous blanching of the other half. This most commonly occurs when the infant is lying on his or her side, with the upper side pale and the
Article
1. Mary L. Williams 1. Dermatology Service, Veterans Administration Medical Center, and Departments of Dermatology and Pediatrics, University of California School of Medicine, San Francisco Seborrheic dermatitis is a common skin condition of infancy of unknown etiology. The disorder is usually mild and responsive to therapy. In severe or atypical cases, a variety of other entities should be considered in the differential diagnosis. Atopic dermatitis, psoriasis, psoriasiform-id reaction, fungal infections, and irritant contact dermatitis can be differentiated on clinical grounds. Less common but more serious disorders, such as histiocytosis X, immunodeficiency disorders, and nutritional and metabolic diseases, may be considered in the child whose disease does not spontaneously resolve or respond satisfactorily to local therapy. Laboratory studies including skin biopsy may be helfpul in these cases. Seborrheic dermatitis is uncommon in children after infancy and before puberty. In this age group, scalp scaling is likely to be due to other causes, such as tinea capitis, atopic dermatitis, or psoriasis.
Article
The vestibular, bullous and pustular disorders of the neonate, infant and child comprise a fascinating array of diseases to challenge the diagnostic and therapeutic acumen of the pediatrician and dermatologist alike. A vesicle is defined as a fluid-filled elevated skin lesion that is less than 1 cm in diameter. When the lesion is larger than 1 cm in diameter, it is termed a bulla. A vesicle or bulla contains clear fluid. A vesicle or bulla containing pus rather than clear fluid is defined as a pustule. The purpose of this article is to present the pediatrician with mechanisms for clinical recognition, laboratory confirmation, and effective therapy of many of the vesicular, bullous and pustular diseases seen in the pediatric population. The transient neonatal disorders will be reviewed in considerable detail, for their recognition may spare a healthy neonate from extensive sepsis work-up, 'shotgun' antibiotic therapy, and prolonged hospitalization with its own inherent morbidity. Several chronic bullous disorders including epidermolysis bullosa, urticaria pigmentosa, and benign chronic bullous dermatosis of childhood will be carefully reviewed and the diagnostic and therapeutic approaches updated. Several vesicular bullous disorders that may occur as acute and episodic severe diseases in children, such as erythema multiforme, toxic epidermal necrolysis, and the staphylococcal scalded skin syndrome are reviewed elsewhere in this issue.
Article
Of 191 children who had had infantile seborrheic dermatitis, 88 were reexamined after 10 years. One child had psoriasis, four had atopic dermatitis, and seven had seborrheic dermatitis, which suggests a link with adult seborrheic dermatitis. A familial tendency toward infantile seborrheic dermatitis was noted, as was an increased incidence of allergy within the family.
Article
Skin diseases in black children differ because of pigment lability, fibroblastic activity, and folliular predominance. Normal findings may include Futcher's or Voight's line, linea alba, Mongolian spot, and pigmentation of the mucous membranes and nails. Disorders that are more frequent in black children are transient neonatal pustular melanosis, infantile acropustulosis, tinea capitis, pomade acne, traction alopecia, and proximal trichorrhexis nodosa. Disorders that vary in appearance but not incidence include pityriasis alba, vitiligo, and alopecia areata. A knowledge of this helps in the treatment of the black child with a skin disorder.
Article
Malassezia furfur is important in the pathogenesis of a number of dermatologic diseases including seborrheic dermatitis in adults. It has also recently been suggested that M. furfur might be the etiologic agent in infantile seborrheic dermatitis (ISD). We studied the presence of M. furfur in 21 children with the clinical diagnosis of infantile seborrheic dermatitis. Laboratory analyses showed aberrant patterns of essential fatty acids (EFA) in serum characterized by elevated levels of 18:1w9 and 20:2w6. Samples for M. furfur were taken from the foreheads and chests of children with infantile seborrheic dermatitis at the time of diagnosis, directly after treatment to complete healing, and after 1 year with no signs of infantile seborrheic dermatitis. All the patients were treated topically with borage oil containing 25% gammalinolenic acid (GLA). No reduced growth of M. furfur was seen on contact plates prepared with borage oil. The growth of M. furfur seems not to be related to the clinical symptoms in ISD.
Article
Cutis marmorata telangiectatica congenita (CMTC) is defined as a localized or generalized reticulated, blue-violet vascular network in skin that is present at birth. The evolution is characterized by rapid improvement within 2 years. Rarely the lesions do not improve very much with age. Few reports include long-term follow-up of CMTC. We report two patients with persistent CMTC, including one with nervous breakdown and failure of laser treatment. The cause and incidence of persistent CMTC is unknown. Parents can be counseled that over time the lesions of CMTC may or not improve. There seems to be no predictive clinical sign. CMTC is usually a benign condition and therapy is rarely discussed. Treatment of persistent CMTC seems difficult and the effectiveness of laser therapy needs to be evaluated.
Article
Erythema toxicum neonatorum (ETN) is a very common disease, but its predisposing factors are still unknown. To determine the predisposing factors of ETN. Seven hundred and eighty-three neonates born in the same hospital during the same period were investigated, and the factors predisposing to ETN were evaluated in a case-control study. (1) The incidence of ETN is about 43.68%, and it is significantly higher in males than in females (p < 0.001). (2) Term birth (p < 0.05), first-pregnancy birth (p < 0.001), the birth season (summer and autumn, p < 0.005), being fed with milk powder substitute or a mixed diet (p < 0.001) and vaginal delivery (p < 0.001) are the predisposing factors of ETN. (3) The severity of ETN in neonates born by vaginal delivery is significantly correlated with the total length of labor (p < 0.001). Our findings suggest that environmental factors play an important role in the onset of ETN.
Article
Birthmarks in newborns are common sources of parental concern. Although most treatment recommendations are based on expert opinion, limited evidence exists to guide management of these conditions. Large congenital melanocytic nevi require evaluation for removal, whereas smaller nevi may be observed for malignant changes. With few exceptions, benign birthmarks (e.g., dermal melanosis, hemangioma of infancy, port-wine stain, nevus simplex) do not require treatment; however, effective cosmetic laser treatments exist. Supernumerary nipples are common and benign; they are occasionally mistaken for congenital melanocytic nevi. High- and intermediate-risk skin markers of spinal dysraphism (e.g., dermal sinuses, tails, atypical dimples, multiple lesions of any type) require evaluation with magnetic resonance imaging or ultrasonography. Family physicians should be familiar with various birthmarks and comfortable discussing disease prevention and cosmetic strategies.
Article
A mother brings her 2 month old child to you with unsightly seborrhoeic dermatitis on his/her scalp. You prescribe 1% hydrocortisone but the mother expresses her unhappiness at using steroids. You remember that the dermatologists at your hospital like to use an antifungal cream and you decide to find out more. In infants with seborrhoeic dermatitis [patient] is there any advantage to using topical antifungals [intervention] over steroids [comparison] to cure seborrhoeic dermatitis of the scalp and prevent recurrences [outcome]? ### Primary source Medline 1966–2003 (Ovid). Subject heading “seborrhoeic dermatitis” + subheadings “therapy AND drug therapy”; 556 articles produced and …