بسم الله الرحمن الرحیم

1. بسم الله الرحمن الرحیم Dr, Z, Badiee neonatologist

2. Neonatal dermatosis Neonatal dermatosis Dr, Z, Badiee neonatologist

3. Common transient cutaneous lesions • Erythema toxicum • Milia • Miliaria • Transient neonatal pustular melanosis • Salmon patch • Mongolian spot Dr, Z, Badiee neonatologist

4. Erythema toxicum Dr, Z, Badiee neonatologist

5. Erythema toxicum • Begin: 24-72 h • New lesions may occur until 2-3 weeks of age • More common in term • Erythematous bases + 1-3 mm papule (white or pale yellow) • Resemble flea bite • Asymptomatic • The sites of predilection : • the face, trunk, proximal arms and buttocks whereas palm and sole involvement is unusual Dr, Z, Badiee neonatologist

6. Erythema toxicum • Red macular areas and wheals range from a few millimeters to several centimeters with superimposed 1 to 2mm papules and pustules • The lesions may be few in number but more often are present in large numbers Etiology : unknown • Gram stain and culture : negative • Wright or Geimsa stain: eosinophils • Resolution: 6-14 days Dr, Z, Badiee neonatologist

7. Erythema toxicum Dr, Z, Badiee neonatologist

8. Transient neonatal pustular melanosis • Incidence: from 0.16 to 15% and the disorder is more common in black • It is a benign condition of term neonates • characterized by: • the presence at birth of pustules or vesicles without surrounding erythema Dr, Z, Badiee neonatologist

9. Transient neonatal pustular melanosis • These vesicopustules rupture easily, with subsequent formation of pigmented macules that are characteristically surrounded by a collarette of scale. These macules may persist for months but usually fade spontaneously within 3 to 4 weeks. Dr, Z, Badiee neonatologist

10. Transient neonatal pustular melanosis • Most commonly affected areas include: the forehead posterior ears chin, neck upper chest, back, buttocks, abdomen, and thighs but all areas may be affected, including the palms and soles. Dr, Z, Badiee neonatologist

11. Transient neonatal pustular melanosis Dr, Z, Badiee neonatologist

12. Wright or Giemsa staining of the pustular contents show neutrophils and occasional eosinophils. • No organisms are observed and bacterial and viral cultures are negative. • Skin biopsy shows intracorneal or subcorneal pustules. Dr, Z, Badiee neonatologist

13. Pustular melanosis Dr, Z, Badiee neonatologist

14. Pustular melanosis Dr, Z, Badiee neonatologist

15. Pustular melanosis Dr, Z, Badiee neonatologist

16. Salmon patch • Other names: nevus simplex • transient macular stains • Angel kiss Dr, Z, Badiee neonatologist

17. Salmon patch • Present in up to 70% normal newborn • Common sites: nape, eyelid, glabella • Most of them fade by 1 year of age • Lesions on neck: more persistent • 25% of adult had neck lesion Dr, Z, Badiee neonatologist

18. Salmon patch Dr, Z, Badiee neonatologist

19. Salmon patch Dr, Z, Badiee neonatologist

20. Mongolian spot • The most common pigmented lesion • Most common in: african- american • Asian • Native american • Common site: lumbosacral area • Macular, gray-blue • Lack of sharp border • May cover an area of 10 cm or larger Dr, Z, Badiee neonatologist

21. Mongolian spot • Delay disappearance of dermal melanocytes • Most of them disappear during first years • Abberant lesions may more likely to persist Dr, Z, Badiee neonatologist

22. Mongolian spot Dr, Z, Badiee neonatologist

23. Mongolian spot Dr, Z, Badiee neonatologist

24. Mongolian spot Dr, Z, Badiee neonatologist

25. Harlequine color change • Most common :First 2- 4 days of life • May occur until 3 weeks • More common in LBW infants • The dependent side : red • Upper side: pale • Sharp midline demarcation • Cause: imbalance in autonomic regulatory mechanism of cutaneous vessels Dr, Z, Badiee neonatologist

26. Harlequine color change Dr, Z, Badiee neonatologist

27. miliaria • obstructions of the eccrine duct resulting in rupture of the ducts and blockage of normal sweating into the skin. • The level of obstruction determines the clinical manifestations. • It can be seen in up to 15% of neonates • occurring more commonly in warm climates, in nurseries without air-conditioning and in febrile infants. Dr, Z, Badiee neonatologist

28. Miliaria crystalina • is the most common type of miliaria • is manifested by minute, non-inflammatory vesicles without surrounding erythema. • These lesions are asymptomatic, superficial and may appear like dewdrops on the skin. • Commonly affected sites : • forehead and upper trunk • Miliaria crystalina represents rupture of the eccrine duct at the level of the stratum corneum Dr, Z, Badiee neonatologist

29. Miliaria crstalina Dr, Z, Badiee neonatologist

30. Miliaria rubra • is due to intraepidermal obstruction of the sweat duct with sweat leakage into the duct and a secondary local inflammatory response. • Lesions are 1-3mm erythematous, non-follicular papules, vesicles or pustules. • Common sites include the face, neck and trunk. Dr, Z, Badiee neonatologist

31. Miliaria rubra • Miliaria rubra occurs later than miliaria crystalina, usually beyond the second week of life. • Occasionally it can progress to pustular lesions (miliaria profunda) • most prominent on the trunk and extremities, and reflects eccrine ductal occlusion at the dermo-epidermal junction. Dr, Z, Badiee neonatologist

32. Milia • These commonly occur on the face and scalp, and consist of tiny white papules which are usually discrete. •   They can however occur anywhere, and may be present at birth or appear subsequently.  • They usually resolve within a few months without treatment. Dr, Z, Badiee neonatologist

33. milia Dr, Z, Badiee neonatologist

34. milia • Milia are inclusion cysts which contain trapped keratinised stratum corneum.  • Similar lesions may be seen in the mouth in some infants: •   When on the hard palate, they are referred to as Epstein's pearls • when on the alveolar ridges, they are called alveolar cysts or Bohn's nodules. Dr, Z, Badiee neonatologist

35. Neonatal Acne • may be present at birth, or develop over the first 2-4 weeks of life.  • Small red papule and pustules on the face • There is controversy over whether it is truly acne or whether it represents a form of pustular disorder in the newborn period.  • As a result, the term neonatal cephalic pustulosis has been mooted. Dr, Z, Badiee neonatologist

36. Dr, Z, Badiee neonatologist

37. Neonatal Acne • The condition consists of pustules over the cheeks primarily, but also involves other areas of the face and the scalp.  • As opposed to infantile acne (which develops after 2 months) and acne of adolescence, there are no comedomes in the neonatal form.  • It may be difficult to differentiate between acne and miliaria rubra. • Neonatal acne resolves spontaneously over several weeks Dr, Z, Badiee neonatologist

38. Acropustulosis of infancy • is a chronic or recurrent benign condition of very pruritic vesicles and pustules occurring on the hands and feet • its etiology is unknown and it affects primarily black boys Dr, Z, Badiee neonatologist

39. Acropustulosis of infancy • Onset: birth to 10 months • continue throughout infancy and early childhood • Infants and children often present with severe prutitus, sleep disturbance, and appetite loss. • Clinical manifestations are limited to the skin, and affected neonates are healthy otherwise. Dr, Z, Badiee neonatologist

40. Acropustulosis of infancy • Cutaneous lesions consist of vesicopustules without surrounding erythema • characteristically involving palms, soles, dorsal hands and feet, and sides of fingers and toes. • Crops of lesions may appear in cycles of two to four weeks, with individual lesions lasting three to seven days. • The number of lesions is greatest in the early episodes, becoming less with subsequent episodes until permanent resolution occurs at 2 to 3 years of age. Dr, Z, Badiee neonatologist

41. Acropustulosis of infancy Dr, Z, Badiee neonatologist

42. Acropustulosis of infancy Dr, Z, Badiee neonatologist

43. Dr, Z, Badiee neonatologist

44. Sucking Blisters • These lesions are present at birth, most often over the dorsal and lateral aspect of the wrist. • Less often, they may be noted more proximally in the forearm. • The infant is noted to exhibit excessive sucking activity. • The absence of lesions in other parts of the body and the otherwise well appearance of the infant would rule out pathological disorders presenting with similar lesions Dr, Z, Badiee neonatologist

45. Sucking Blisters Dr, Z, Badiee neonatologist

46. Sucking Blisters Dr, Z, Badiee neonatologist

47. Aplasia cutis • Local absence of skin at birth • Most often: on the scalp midline • Occatinaly other parts: trunk, extrimity • Possible ethiology: • incomplete closure of the neural tube • Localized vascular insufficiency • Intrauterin infection • large scalp defet: associated with trisomy 13 • Management: observation, prevention of infection, surgical excision, skin graft. Dr, Z, Badiee neonatologist

48. Cutis aplasia Dr, Z, Badiee neonatologist

49. Aplasia cutis Dr, Z, Badiee neonatologist

50. Subcutaneous fat necrosis • Localized • Sharply circumscribe • Appear 1-4 weeks after delivery • Small nodules or large plaques • Cheeks • Buttocks • Back • Arms • thighs Dr, Z, Badiee neonatologist