Neonatal Dermatology Common conditions Vernix Caseosa White/grey, greasy covering on newborn skin Made up of sebum and sloughed

epidermal cells No treatment needed Sheds within 1 wk

Milia 1mm, firm papules on the face and sometimes on the trunk and legs Can also occur in the oral mucosa epsteins pearls 40% of term babies It is a keratinous cyst from a hair follicle No treatment required

Erythema Toxicum Neonatorum Maculo-papular rash with pustules and surrounding erythematous wheals Common on the trunk, face and extremities with sparing of palms and soles Affects 40-70% of term babies Not common in pre-terms Typically appears on day 1-2 of life and then waxes and wanes Scrape sample reveals numerous eosinophils No treatment required resolves over 2-4 weeks

Cutis Marmorata Mottling of the newborn skin (most common in pre-terms) Symmetrical Blanching Red/blue telangectasia Intermittent appearance Caused by immature vasomotor responses Should resolve by 1 year of age If not resolved by 6 mths consider referall as it may be associated with CHD/trisomy/thyroid disorders -

Transient Neonatal Pustular Melanosis 0-2-4% of all new borns More common in black babies Lesions on the trunk, face, extremities and palms/soles 3 stages: 1-5mm fragile pustules Resolution of pustules with colarettes of fine white scale Hyperpigmentation of the affected areas No treatment required

Sebaceous gland hyperplasia Pinpoint yellow papules Predominantly on the nose, cheeks, forehead and upper lip Caused by maternal androgenic stimulation in the last gestational month No Rx required spontaneously resolves

Neonatal Acne (aka neonatal cephalic pustulosis) Monomorphic inflammatory papules on the face, scalp and neck Comedones are absent Male to female ratio 1:1 Possible inflammatory reaction to malassezia fufur/sympodialis Usually resolves spontaneously but can be treated with topical ketokonazole/miconazole

Can present with CCF if there are multiple/visceral lesions Kasabach-Merrit Syndrome: Rapidly expanding haemangioma assc w/ thrombocytopenia and consumptive coagulopathy (DIC) Treatment = laser or excision surgery

Salmon patch An area of pink skin usually over the forehead, upper eyelids or neck Capillary malformations Those over the eyelids usually resolve/fade They can persist, or becomes obvious in adulthood with facial flushing

Umbilical granuloma Pink papule or nodule Endothelial proliferation at the site of the umbilical cord remnant Can be removed with SN cautery If persists indicates remaining umbilical remnant

Port Wine Stain A capillary malformation present from bith Assc w/ sturge webber syndrome/kippel trenauny syndrome Persists throughout life Can be treated with pulses dye laser

Congenital Defects/Birthmarks Strawberry Naevi (capilliary haemangioma) The commonest tumour in infancy Presents in the first of weeks of life Increased incidence in pre-terms/CVS The precursor is an erythematous/telangectasic patch Usually a focal solitary lesion on the head or neck (60%) 3 phases of development Proliferative (over 6-10 mths) Stabilisation Spontaneous resolution By 5 years 50% have resolved By 7 years 70% 90% by 9 years 50% will leave some degree of permanent skin change or scar Treat if obstructing position; impinging on vision or if ulcerated/bleeding significantly

Sebaceous Naevi Present at birth Usually on the face/scalp Overgrown epidermis/sebaceous glands and hair follicles Smooth, raised, orange hairless patch Increasingly pronounced in adolescence bumpy and warty

Melancytic naevi (aka moles) A proliferation of melanocytes Flat or protruding in varying colours Congenital usually >5mm Acquired usually < 5mm Bathing suit distribution covering almost whole trunk = giant melanocytic naevi = increased risk of melanoma

Aplasia cutia congenita 1/5000 births The absence of skin in a localised or widespread areas at birth Most commonly noted on the posterior scalp May be associated with other anomalies and chromosomal disorders Grp 1: no anomalies Grp 2: assc w/ limb anomalies i.e. club foot = Adams Oliver Syndrome Grp3: assc w/ epidermal or sebaceous naevi Grp 4: assc w/ embryological malformations Grp 5: assc w/ placental infarcts Grp 6: assc w/ epidermolysis bullosa Aetiology is unknown Histology shows absent or thinned epidermis with thinned dermis Keep clean and apply topical antibiotics if ulcerated Hair grafting Genetic counselling recommended Isolated lesions have good prognosis Most heal without treatment Note risk of infection if dura is exposed Associated syndromes/defects may alter prognosis

30% of babies will also suffer congential heart block, some requiring a pacemaker Mothers are often asymptomatic, but the baby is affected by transfer of IgG antibodies across the placenta Treat according to severity Suncream Steroids; topical or systemic Cardiology consult

Skin manifestations of Neonatal Infections Neonatal Erythroderma (red skin) DDx : Skin disorders seborrhoeic dermatitis Eczema Psoriasis Ichthyosis

Amniotic Band Syndrome Autoimmune disorders Neonatal SLE 2 forms of cutaneous findings Papulosquamous and annular Most commonly distributed on the face Usually develop w/in the first few weeks on exposure to light Can persist up to 6/12 mths but fade as maternal antibodies wane 95% of mothers have anti-ro and anti-la (70-80%) autoantibodies

Metabolic/nutritional disorders Zinc deficiency CF Protein malnutrition Carboxylase deficiencies

Immune disorders Di George syndrome T cell lymphoma

Hypogammaglobulinaemia Graft versus host disease