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Other Infantile Rashes

Other Infantile Rashes. Milia. Tiny, whitish-yellow, firm papules Face of neonates Small epithelial-lined cysts Arise from hair follicles Persistent May resolve after months to years Timing Neonates Older children after skin injury. Miliaria Crystallina.

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Other Infantile Rashes

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  1. Other Infantile Rashes

  2. Milia • Tiny, whitish-yellow, firm papules • Face of neonates • Small epithelial-lined cysts • Arise from hair follicles • Persistent • May resolve after months to years • Timing • Neonates • Older children after skin injury

  3. MiliariaCrystallina • Cause: obstruction of eccrine sweat ducts • Description: • multiple 2-3mm sweat retention vescicles • Easily rupture • Location • Infants: Head, neck, upper trunk • Older Children: areas of desquamating sunburn

  4. MiliariaRubra • Aka “Prickly Heat” • Cause: • sweat duct obstruction in deeper layers • Results from use of thick lubricants or tight-fitting clothing in hot, humid weather • Description: erythematouspapulopustular eruption • Locationface, upper trunk, intertriginous areas of neck

  5. Infantile Acropustulosis • Etiology unknown • Course: • wax/wanes • Crops over hands/feet • Resolve over 10-21 days • Recur within few wks • Resolves by age 3y/o

  6. Infantile Acropustulosis • Description • Pinpoint erythematous papules • Evolve to papulopustules or vesiculopustules • Pruritic • Treatment • Topical steroids • Antihistamines (itching)

  7. Seborrhea • Location • Hair-bearing and intertriginous areas • “Cradle cap” … infants • Scalp, eyebrows, eyelashes, perinasal, presternal, postauricular, neck, axillae, groin • May become generalized • Description • Red, scaling eruption • Nonpruritic, mild

  8. Seborrhea • Pathogenesis • Unknown • Pityrosporum and Candida • Treatment • May resolve spontaneously • Antifungal cream • Low-potency topical steroid • Antiseborrheic shampoos

  9. Diaper dermatitis

  10. Irritant Diaper Dermatitis • Multiple factors • Urine and stool • Ammonia formation • Occlusion by plastic diapers • Soaps and detergents • Spares intertriginous areas • Treatment • Frequent changes • Gentle cleansing • Application of barrier pastes • Topical steroids may be helpful

  11. Candidal Diaper Dermatitis • Description • Bright red eruption, sharp borders, pinpoint satellite papules and pustules • Intertriginous areas • KOH: Budding yeast and pseudohyphae • May have oral thrush • Treatment • Topical antifungals • May require brief course oral treatment

  12. Staph Diaper Dermatitis • Description • Thin-walled pustules on erythematous base • Larger than cadida pustules • Rupture and dry: collarette of scaling around denuded base • Treatment • Oral and topical abx

  13. Seborrheic Diaper Dermatitis • Description • Salmon-colored lesions w yellow scale • Prominent in intertriginous areas • No satellite lesions • Sebderm of scalp, face, postauricular areas seen • May have concurrent infxn with Candida or Pityrosporum

  14. Tinea Diaper Dermatitis • Description • Recalcitrant scaly eruption with elevated or “active” scaly border • Scales can be scraped and demonstrated on KOH • Treated with topical antifungals • Do NOT use topical steroids

  15. Question 7 A scraping of the skin lesions that appeared 24h after birth in the otherwise healthy neonate shown will likely reveal • Mulitnucleated giant cells • Neutrophils • Mastocytes • Eosinophils • Gram-positive bacteria

  16. Neonatal Dermatology

  17. Mongolian Spots • Description • Flat, slate-gray to bluish-black, poorly circumscribed macules • Location • Lumbosacral and buttocks • Can appear anywhere • Size • 1-10cm • Single or Multiple • Ethnicity • 90% AA • 80% Asian • 10% Caucasian • Path • Accumulations of melanocytes deep within dermis • Fade by age 7

  18. ErythemaToxicumNeonatorum • Benign, self-limited • Incidence • 50% full-term infants • Timing • 24-48h after birth • Up to 10th day • Description • Intense erythema with a central papule or pustule • Few to several hundred • Size • Pustule is 2-3mm • Location • Back, face, chest, extremities • Palms and soles spared • Smear • Eosinophils • May have a concurrent circulating eosinophilia • Course • Fades in 5-7d

  19. Transient Neonatal PustularMelanosis • Timing • Present at birth • Description • 1-2mm vesicopustules • Ruptured pustules in 24-48h • Pigmented macules with a collarette of scale • Location • Neck, forehead, lower back, legs • Can occur anywhere • Smear • Neutrophils • Course • Hyperpigmentation fades in 3wks to 3 months

  20. Sebaceous Gland Hyperplasia • Common • Description • Multiple 1-2cm yellowish-white papules • Location • Nose and cheeks • Cause • Normal physiologic response to maternal androgen stimulation • Course • Resolve by 4-6 months

  21. Neonatal Cephalic Pustulosis (Neonatal Acne) • Description • Papules and papulopustules • Location • Face, neck and trunk • Cause • Hormonal stimulation of sebaceous glands • Overgrowth of yeast • Course • Benign and self-limited • Topical antifungals

  22. Cutis Marmorata • Description • Transient, netlike, reddish-blue mottling of the skin • Cause • Variable vascular constriction and dilatation • Location • Symmetrically over the trunk and extremities • No treatment • Normal response to chilling • Abates by 6 months

  23. EpidermolysisBullosa • EB simplex • AD • Description • Superficial blisters or just above basal cell layer of epidermis • Mild to severe blistering • Location • Widespread • Pressure bearing areas • After intense physical activity • Timing • Later infancy, childhood or adolescence • Course • No scarring • Secondary infections • Some with atrophy

  24. EpidermolysisBullosa • JunctionalEpidermolysisBullosa • AR • Description • Presents at birth • Generalized bullae and erosions • Junction of epidermis and dermis • Course • Severe variant • Fatal within first year • Mild variant • Resembles generalized EB

  25. EpidermolysisBullosa • Dystrophic EpidermolysisBullosa • Dominant and Recessive • Description • Deep within the upper dermis • Scarring with milia • Course • Dominant • Localized (feet) • Recessive • Growth and development retardation • Severe oral blisters • Loss of nails • Syndactyly

  26. EpidermolysisBullosa • For all types • Diagnosis • Skin biopsy • Prenatal gene testing • Treatment • Symptomatic • Supportive

  27. IncontinentiaPigmenti • X-linked dominant • Seen mostly in females • Lethal in most males • 3 phases (may present in any phase) • First phase • Inflammatory vesicles or bullae • Trunk and extremities • First 2 weeks of life • New blisters • Next 3 months • Biopsy • Inflammation with intraepidermaleosinophils and necrotic keratinocytes

  28. IncontinentiaPigmenti • 3 phases • Second phase • Irregular, warty papules • Resolves spontaneously within several months • Third phase • Swirling or streaking pattern (Blaschkoid distribution) of brown to bluish-gray pigmentation on the trunk or extremities • Lasts many years but gradually fades • Leaves subtle, streaky, hypopigmented scars

  29. IncontinentiaPigmenti • Systemic manifestations • 30% CNS • Seizures • MR • Spasticity • 35% Ophthalmic • Strabismus • Cataracts • Blindness • Microphthalmia • 65% • Pegged teeth • Delayed dentition • Treatment • None

  30. Question 8 The parents of this newborn infant pictured are inquiring about treatment for the lesion shown. What do you tell them? • The infant is at a high risk for cancer with this lesion and needs referral to surgery for excision • This is a normal variant and the lesion will fade over the first year of life. No treatment is necessary • The infant should be referred to dermatology for pulsed laser therapy • While the lesion will not change with time, treatment should be delayed for at least a year • An oral course of steroids is necessary to help resolve the lesion

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