WVSOM -- Neonatal Dermatology
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| How is newborn skin different from adult? | thinner, weaker intercellular attachments, fewer sweat adn sebaceous glands, few melanocytes, less terminal hair, greater skin surface to body ratio
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| what is the consequences of newborn skin differences? | inc. permeablity to topical agents; greater tendancy to blister; inc photosensitivity; dec response to tehrmal stress
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| What is skin like in preterm infants? | even thinner skin; few attachemnts; no eccrine glands; persistent lanugo
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| what is lanugo | ting and short body hair (peach fuzz); thins at 30 weeks
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| what is cause of most office visits for newborn dry skin? | desquamation
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| What happens to new born skin at 24-36 hour? | desquamation
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| how long does it take for desquamation to occur? | 21 days
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| what is desquamation? | shedding of outer layer of skin
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| what is acrocyanosis? | cyanosis aond hands and feet; must be differentiated form central cyanosis; caused by increased tone of peripheral areterioles in response to chilling
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| what is cutis marmorata | Netlike, reddish-blue mottling of the skin; normal response to chilling; can be a sign of sepsis; goes away with rewarming
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| what is ichtyosis | aka collodion baby; parchemnt-like collodion membrane that distorts the face adn extremities
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| what happens to the membrane in icthyosis? | membrane usually resolves into scales over time
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| what are sucking blisters? | superficial bullae present on upper limbs at birth; result of vigorus sucking in-utero
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| What is miliaria | sweat gland obsturction form over bundling
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| what is miliaria crystallina? | clear vesicles over head, neck and upper trucnk
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| waht is miliaria rubra | prickly heat; sites of occlusion or flexural areas
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| what is milia | tiny whitish-yellow papules containing keratin on NOSE, forehead adn chin
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| what is neonatal acne | resembles teenage acne with comedones, paules and pustules
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| what is erythemia toxicum neonatorum | intense erythema with central 2mm papule or pustule (fleabite); not on palms; smear of pustures reveals numerous eosinophils; fades in 5-7 days
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| what is transient neonatal pustular melanosis | pigmented macules with a scale (1-2mm); numerous neutrophils; reluves in 3 weeks
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| what is seborrheic dermatitis? | red, scaling eruption mainly on hair-bearing and intertriginous areas; cradle cap
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| what are mongolian spots? | flat, gray to bluish-black macules commonly over lumbosacral area; usually fade by age7; no risk of malignancy; may be confused with child abuse
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| what are congenital nevi | flat, tan macules or papules and well circumscribed
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| What needs to be followed throught out life with congential nevi | size, shape, outline, color, burning, itching, tenderness; may progress to melanoma
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| what size are small/medium congential nevi? | up to 20 cm
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| what are giant congential nevi? | > 20cm; unevenly pigmented with colors from borwn to black; removed as early as possible; requries close obersrvation with palpation of entire lesion even after exision because it may arise deep without visible skin change
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| What are hemangiomas? | most common benign tummor that is filled with blood when in a dependent position; composed of proliferating vascular end
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| what is a superficial hemangiomas? | strawberry capillary hemangioma; head and neck; infolution by age 6
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| what are deep hemangiomas | deep seated capillary showing as bluish-red mass
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| what are complications of hemantiomas? (facial) | beard distribution (airway compromise); near the eye
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| Waht are lumbosacral complciations of hemangiomas | tethered cord; spinal dysraphism; imperforate anus; renal anomalies; sacral anomalies
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| what is PHACE syndrome | Posterior fossa/brain malmoration; Head/cervicofactial hemangioma; arterial anomalies; cardiac defects or coarctaion of aorta; eye anomolies
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| what is Kasabach-Merritt Syndrome? | rapidly enlarging hemangioma causing; Thrombocytopenia; microangiopathic hemolytic anemia; coagulopathy from RBC adn platelet trapping; activation of teh clotting system within the hemangioma
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| what is treatment of hemangiomas | OBSERVATION AS MOST HAVE SPONTANEOUS INVOLUTION; if complications: steroids; interferon; steroid injections; laser therapy; surgical resection
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| what is salmon patch? | vascular ectasia; symmetric with lesions on both sides of midline
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| what is port wine stain | present on head and neck; permanent; mature dilated dermal capillaries and represent a permanent defect
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| Sturge-Weber Syndrome | port-wine stain over teh ophthalmic branch of trigeminal nerve; intracranial calcifications; seizures; hemiparesis; glaucoma; mental retardation
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| Kklippel-trenaunay weber syndrome | port wine stain on extremity associated with local overgrowth of stoft tissue and bone; lower limb; leg-length discrepancies
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| What is TORCH | Toxoplasmosis, Other(syphallis), rubella, cytomegalovirus, herpes
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| What is toxoplasmosis | silent infection in pregnant women; hydrocephalus, chorioretinitis, intracerebreal calcifications
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| what do infants with toxoplasmosis have a risk for? | neurodevelopmental sequelae (seizures, developmental delays, paralysis, difficulty swallowing)
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| How is congenital syphilis mostly seen? | majority asymptomatic at birth but manifest symptoms if left untreated
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| what is seen in early syphilis | large round maculoapular lesions anywhere but also palms and soles; perioral fissures and scarring; lymphadenopathy; rhinitis; osteochondritis
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| what is seen in late syphilis | hutchinson teeth and mulberry molars;8th never deafness; sabre shin; saddle nose deformity
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| what are hutchinson teeth? | upper central incisors are small, barrel shaped and notched in teh center
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| What are mulberry molars | multiple peripheral cusps and a central cusp
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| what is seen in congenital rubella? | cataracts, deafness, heart malfomrations, blueberry muffin rash
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| what is blueberry muffin rash? | dermal erythropoiesis
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| what is seen in infants with CMV? | majority asymptomatic; may develop sensoineural hearing loss; periventricular calcificaitons, blueberry muffin rash, microcephally, thrombocytopenia, choriorentitis
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| what is seen with neonatal herpes | mother may never have had lesions; vesicle with erythematous halo
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| what is seen in disseminated neonatal herpes | respiratory distress, hepatitis, DIC, FOCAL SEIZURES
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| what is seen with encehpalitic herpeis? | focal seizures; bloody lumbar puncture
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| when are cutaneious manifestaions of herpes seen? | 3rd week of life
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