SKIN ISSUES IN BABIES-PART 2
📌ERYTHEMA TOXICUM NEONATORUM
📌TRANSIENT NEONATAL PUSTULAR MELANOSIS
📌Miliaria
📍MILIARIA CRYSTALLINA
📍MILIARIA RUBRA (‘PRICKLY HEAT’)
*Usually seen after the first week of life
*The obstructed flow leads to leakage of fluid into the lower epidermis and upper dermis, resulting in an inflammatory response that produces small erythematous papules, papulovesicles, and pustules.
*Frequently, some of the lesions are pustular (miliaria pustulosa), but this does not necessarily indicate secondary infection.
📍MILIARIA PROFUNDA
*It very uncommon in neonates as it usually occurs in adults where there have been repeated episodes of miliaria rubra and there is even deeper obstruction of the eccrine duct.
Management
*Milaria crystallina spontaneously improves without therapy over a few weeks as the sweat ducts mature.
*Miliaria rubra will improve in a few weeks without medical treatment if the child is removed from conditions of high heat/humidity and any occlusive clothing or bedding is removed
*Topically, a soothing agent like calamine lotion is useful.
*Antibiotics may be needed if staphylococcal infection occurs.
📌INFANTILE ACROPUSTULOSIS*Disorder of unknown aetiology.
*It has also been suggested that, at least in some cases, infantile acropustulosis occurs following successful treatment of scabies .
*The onset is in the first year of life, particularly during the first 6 months .
*Presentation- recurrent crops of intensely itchy, 1–4 mm vesicopustules
*Site- mainly on the soles and sides of the feet, and on the palms, but may also occur on the dorsa of the feet, hands and fingers, and on the ankles, wrists and forearms.
*Each crop occurs at an interval of 2-4 weeks and lasts for 7–14 days.
*Tiny red papules, vesicles, pustules, Excoriation, erosions, crusting
*Heals by post inflammatory hyperpigmentation
*Skin biopsy of a pustule- well circumscribed subcorneal or intraepidermal aggregations of neutrophils, with a sparse perivascular lymphohistiocytic infiltrate in the underlying papillary dermis
*Treatment :
-Potent topical corticosteroids with or without occlusion.
-Dapsone ( 2 mg/kg body weight per day in two divided doses ) has been used in a few severe cases
-Topical maxacalcitol.
-Frequency of attacks decreases as age progresses and cease within 2 years of onset.
📌DIAPER RASH/NAPKIN RASH/NAPPY RASH/DIAPER DERMATITIS
*Diaper dermatitis is one of the most common skin problems in the newborn.
*Term “diaper dermatitis” mean any skin disease in the diaper area.
*Neonatal skin is irritated with contact from urines, feces and occlusive condition
*Three common types of diaper dermatitis are are -
1) Frictional dermatitis : friction with skin and fabric leads to a breach in stratum corneum, sp. Over perineal area, buttock, and waistlines.
2) Irritant contact dermatitis : due to contact with proteolytic enzyme in stool ,chemical like soap, detergents. It involves convex surface of buttock, vulva, perineal area, lower abdomen, and proximal thigh sparing intertriginous area.
3) Diaper candidiasis
*Treatment :
-Gentle cleansing with a soft moist cloth, exposure to air.
-Topical zinc oxide and petrolatum have good barrier function.
-Hydrocortisone cream 2 -3 times daily till clinical improvement.
📌APLASIA CUTIS CONGENITA
*It is a focal congenital, localized absence of skin usually noted on the scalp as multiple or solitary, non-inflammatory, well-demarcated, oval or circular 1-2 cm ulcers.
*Those that are formed in early gestation may heal before delivery and appear as an atrophic, fibrotic scar with associated alopecia, whereas defects that are more recent may present as an ulceration.
*Aplasia cutis congenita may be associated with under lying embryologic malformation such as meningomyelocele, omphalocele or spinal dysraphism.
*Found in extremely premature babies (<29 weeks).
📌ANETODERMA OF PREMATURITY
*Anetoderma is due to loss of elastic tissue in the dermis and presents with atrophic lesions that often herniate.
*The underlying cause is unknown.
*Presents with nummular areas of cutaneous atrophy appearing on the trunk and/or proximal limbs within a few weeks of birth
*It is non‐progressive and persistent.
*A skin biopsy of a lesion shows reduced or absent elastic tissue.
*There is no known treatment for anetoderma.
📌COLLODION BABY
*Highly characteristic clinical entity present at birth where a child is born with an ‘extra’ skin resembling a shiny membrane or collodion.
*The severely affected infant is bright red and encased in a taut, glistening, yellowish, translucent covering resembling colloidon
*The face is immobilized; tension on the skin results in ectropion and eclabion (eversion of the lips)
*Almost 90% of collodion babies will go on to develop a severe form of autosomal recessive ichthyosis in the first few weeks of life:
-lamellar ichthyosis
-non‐bullous ichthyosiform erythroderma (syn. congenital ichthyosiform erythroderma)
*Within hours, this membrane dries and cracks, and bleeding may occur Within 1 or 2 days, it starts to peel off The shedding will more or less complete within 4 weeks Subsequently, the typical features of one of several varieties of ichthyosis gradually emerge over a period of weeks or months.
*Complications and co‐morbidities
-Impaired temperature regulation.
-Increased insensible water loss, hypernatraemic dehydration and acute renal failure .
-Septicaemia .
-Percutaneous toxicity from topical medications (increased absorption).
-Respiratory failure
*MANAGEMENT
-Incubation in a high‐humidity atmosphere, with careful monitoring of body temperature.
-Fluid and electrolyte balance.
-Fluid loss is significantly reduced by frequent applications of lipid, a mixture of white soft paraffin and liquid paraffin is ideal.
-Frequent oiling.
📌BLUEBERRY MUFFIN BABY
(DERMAL ERYTHROPOIESIS)
*Characteristic eruption in neonates, often present at birth, comprising widespread, purple, erythematous, oval or circular macules , papules and nodules reflecting dermal erythropoiesis.
*Sites - trunk, head and neck.
*The lesions generally fade into light brown macules within a few weeks of birth.
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