Other Infantile Rashes

Tiny, whitish-yellow, firm papulesFace of neonatesSmall epithelial-lined cysts

Arise from hair folliclesPersistent

May resolve after months to yearsTiming

NeonatesOlder children after skin injury

Milia

Cause: obstruction of eccrine sweat ducts

Description: multiple 2-3mm

sweat retention vescicles

Easily ruptureLocation

Infants: Head, neck, upper trunk

Older Children: areas of desquamating sunburn

Miliaria Crystallina

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: erythematous papulopustular eruption

Locationface, upper trunk, intertriginous areas of neck

Miliaria Rubra

Etiology unknownCourse:

wax/wanesCrops over hands/feetResolve over 10-21 daysRecur within few wksResolves by age 3y/o

Infantile Acropustulosis

DescriptionPinpoint erythematous papules

Evolve to papulopustules or vesiculopustulesPruritic

TreatmentTopical steroidsAntihistamines (itching)

Infantile Acropustulosis

LocationHair-bearing and intertriginous

areas“Cradle cap” … infantsScalp, eyebrows, eyelashes,

perinasal, presternal, postauricular, neck, axillae, groin

May become generalized

DescriptionRed, scaling eruptionNonpruritic, mild

Seborrhea

PathogenesisUnknownPityrosporum and Candida

TreatmentMay resolve spontaneouslyAntifungal creamLow-potency topical steroidAntiseborrheic shampoos

Seborrhea

Diaper dermatitis

Multiple factorsUrine and stool

Ammonia formationOcclusion by plastic diapersSoaps and detergents

Spares intertriginous areasTreatment

Frequent changesGentle cleansingApplication of barrier pastesTopical steroids may be helpful

Irritant Diaper Dermatitis

DescriptionBright red eruption, sharp

borders, pinpoint satellite papules and pustules

Intertriginous areasKOH: Budding yeast and

pseudohyphaeMay have oral thrush

TreatmentTopical antifungalsMay require brief course

oral treatment

Candidal Diaper Dermatitis

DescriptionThin-walled pustules on

erythematous baseLarger than cadida pustules

Rupture and dry: collarette of scaling around denuded base

TreatmentOral and topical abx

Staph Diaper Dermatitis

DescriptionSalmon-colored lesions w yellow

scaleProminent in intertriginous areasNo satellite lesions

Seb derm of scalp, face, postauricular areas seen

May have concurrent infxn with Candida or Pityrosporum

Seborrheic Diaper Dermatitis

DescriptionRecalcitrant scaly

eruption with elevated or “active” scaly border

Scales can be scraped and demonstrated on KOH

Treated with topical antifungalsDo NOT use topical

steroids

Tinea Diaper Dermatitis

A scraping of the skin lesions that appeared 24h after birth in the otherwise healthy neonate shown will likely reveal

A. Mulitnucleated giant cells

B. NeutrophilsC. MastocytesD. EosinophilsE. Gram-positive bacteria

Question 7

Neonatal Dermatology

Description Flat, slate-gray to bluish-black, poorly

circumscribed maculesLocation

Lumbosacral and buttocks Can appear anywhere

Size 1-10cm

Single or MultipleEthnicity

90% AA 80% Asian 10% Caucasian

Path Accumulations of melanocytes deep

within dermisFade by age 7

Mongolian Spots

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

Erythema Toxicum Neonatorum

TimingPresent at birth

Description1-2mm vesicopustulesRuptured pustules in 24-48h

Pigmented macules with a collarette of scale

LocationNeck, forehead, lower back, legsCan occur anywhere

SmearNeutrophils

CourseHyperpigmentation fades in

3wks to 3 months

Transient Neonatal Pustular Melanosis

CommonDescription

Multiple 1-2cm yellowish-white papules

LocationNose and cheeks

CauseNormal physiologic

response to maternal androgen stimulation

CourseResolve by 4-6 months

Sebaceous Gland Hyperplasia

DescriptionPapules and

papulopustulesLocation

Face, neck and trunkCause

Hormonal stimulation of sebaceous glands

Overgrowth of yeastCourse

Benign and self-limitedTopical antifungals

Neonatal Cephalic Pustulosis (Neonatal Acne)

DescriptionTransient, netlike, reddish-

blue mottling of the skinCause

Variable vascular constriction and dilatation

LocationSymmetrically over the

trunk and extremitiesNo treatment

Normal response to chillingAbates by 6 months

Cutis Marmorata

EB simplexADDescription

Superficial blisters or just above basal cell layer of epidermis

Mild to severe blisteringLocation

Widespread Pressure bearing areasAfter intense physical activity

TimingLater infancy, childhood or

adolescenceCourse

No scarringSecondary infectionsSome with atrophy

Epidermolysis Bullosa

Junctional Epidermolysis BullosaARDescription

Presents at birthGeneralized bullae and

erosions Junction of epidermis

and dermisCourse

Severe variantFatal within first year

Mild variantResembles generalized

EB

Epidermolysis Bullosa

Dystrophic Epidermolysis BullosaDominant and RecessiveDescription

Deep within the upper dermisScarring with milia

CourseDominant

Localized (feet)Recessive

Growth and development retardation

Severe oral blistersLoss of nailsSyndactyly

Epidermolysis Bullosa

For all typesDiagnosis

Skin biopsyPrenatal gene

testing

TreatmentSymptomaticSupportive

Epidermolysis Bullosa

X-linked dominantSeen mostly in femalesLethal 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

intraepidermal eosinophils and necrotic keratinocytes

Incontinentia Pigmenti

3 phasesSecond phase

Irregular, warty papulesResolves spontaneously

within several monthsThird 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

Incontinentia Pigmenti

Systemic manifestations30% CNS

SeizuresMRSpasticity

35% Ophthalmic StrabismusCataractsBlindnessMicrophthalmia

65%Pegged teeth Delayed dentition

TreatmentNone

Incontinentia Pigmenti

The parents of this newborn infant pictured are inquiring about treatment for the lesion shown. What do you tell them?

A. The infant is at a high risk for cancer with this lesion and needs referral to surgery for excision

B. This is a normal variant and the lesion will fade over the first year of life. No treatment is necessary

C. The infant should be referred to dermatology for pulsed laser therapy

D. While the lesion will not change with time, treatment should be delayed for at least a year

E. An oral course of steroids is necessary to help resolve the lesion

Question 8