SKIN ISSUES OF BABIES-PART 1

SKIN   ISSUES   OF   BABIES

📌What is meant by:-

*Neonatal period- 1st 4 weeks of extrauterine life

*Infancy- first year of extrauterine life

*Preterm- born before 37th week of gestation

*Full term- 37-42 weeks of gestation

*Post term- after 42 weeks

*Low birth weight- < 2500g

*IUGR- birth weight low for gestational age (SGA)

📌TRANSIENT PHYSIOLOGICAL CHANGES IN BABIES

📍VERNIX CASEOSA

📍PERIPHERAL CYANOSIS/ ACROCYANOSIS

📍ERYTHEMA NEONATORUM

📍HARLEQUIN COLOUR CHANGE

📍CUTIS MARMORATA

📍MONGOLIAN SPOT

📍SEBACEOUS GLAND HYPERPLASIA

📍MILIA

📍DESQUAMATION

📍MACULAR HEMANGIOMA

📍MINIATURE PUBERTY

📍SUCKING BLISTERS

📍NEONATAL OCCIPITAL ALOPECIA

📍NEONATAL ACNE

📍LANUGO

📍VERNIX CASEOSA

*At birth the skin is covered with a whitish, greasy film.This is called vernix caseosa.

*Cover the entire skin surface, or it may be present only in body folds such as the groins.

*Comprised of lipids and contains antimicrobial peptides.

*Golden yellow staining - Haemolytic disease of the newborn and postmaturity.

* Fetal distress in utero may lead to staining of the vernix by bile pigments present in meconium.

*Infected vernix has a characteristic odour that indicates neonatal sepsis.

*FUNCTIONS OF VERNIX CASEOSA:-

1. Maintenance of skin hydration at birth

2. Provides anti-infective  environment

3. Helps in skin cleansing

4. Acts as physical barrier

5. Thermal regulation at birth

6. Antioxidant properties

7. Wound healing properties

📍ERYTHEMA NEONATORUM

*A few hours after birth, many babies have generalized hyperaemia usually known as erythema neonatorum, which fades spontaneously within 24–48 h.

📍ACROCYANOSIS

*Acrocyanosis is a skin manifestation in newborn, which occurs due to vasomotor instability. 

*Acrocyanosis is characterised by bilateral and symmetric bluish discolouration of the hands and feet sparing the warmer parts of the body.

*It is more common in full term neonate.

*The cyanotic hue disappears on warming the extremities.

*It is prominent in hypothermic newborns and in newborns with polycythaemia and other hyperviscosity syndromes. 

*Acrocyanosis has no pathological significance and its disappears in first few weeks of life.

📍HARLEQUIN  COLOUR  CHANGE

*Harlequin colour change occurs when the newborn is made to lie on his/her side.

* It is a vascular event, which involves erythema of the dependent part of the body and simultaneous paleness or blanching of the contralateral side. 

*There is a sharp demarcation line present between the erythematous and pale zones.

*There is a wide variation in the duration of attacks, but generally, it is  30 seconds to 20 min.

*It is thought to be secondary to a relative hypothalamic control immaturity of the sympathetic peripheral vascular tonus.

*No therapy is required and increased activity like crying usually ablates the colour change.

*As the skin matures, this vascular phenomena disappear.

*If it persists beyond the end of the fourth week, it may be associated with hypoxia due to cardiovascular anomalies.

📍CUTIS MARMORATA

*Cutis marmorata is a transient, benign, reticulated mottling of the skin that symmetrically involves the trunk and extremities. 

*It is caused by a vascular response to cold and generally resolves when the skin is warmed.

* No treatment is indicated for cutis marmorata. 

*Its persistence is seen in Down syndrome, trisomy 18, hypothyroidism.

*Physiologic cutis marmorata needs to be differentiated from cutis marmorata telangiectatica congenita (CMTC).

 *It is a congenital vascular anomaly characterised by persistent cutis marmorata and  phlebectasia, and sometimes cutaneous atrophy and skin ulceration.

📍MONGOLIAN SPOT

*Most frequently encountered pigmented lesion.

*Are collections of melanocytes located in the dermis. 

*Benign, blue-gray or blue-black patches, usually located over the sacrum or lower back.

*Blue colour of dermal melanosis is due to the Tyndall effect, in which red wave lengths of light are absorbed and blue wave lengths are reflected back from the brown melanin pigment which is located deep in the dermis.

*Cause- it is thought to be arrested embryonal migration of melanocytes from neural crest to epidermis resulting in dermal melanocytosis.

*Lesions can range from a few millimeters to more than 10 cm and may be single or multiple.

*Lesions also occur on the buttocks, dorsal trunk and extremities.

*Usually lesion colour stabilizes in infancy, and the lesion disappear in almost all patients before puberty.

📍SEBACEOUS GLAND HYPERPLASIA

*These are tiny monomorphous pinhead-sized lesions, white or yellow in color, seen over the nose, upper lip, malar region, forehead and chin.

*Manifestation of maternal androgen stimulation.

*They represent hyperplastic sebaceous glands and fade in the first few weeks of life

📍MILIA

*About 40% of neonates have multiple, pearly white, or yellow papules, 1-3 mm in size, scattered over the cheeks, nose, nasolabial folds, forehead, and rarely over the foreskin. 

*Histologically, these are tiny follicular epidermal cysts that contain laminated keratin.

 *Disappear usually with in first month of life

📍MACULAR HEMANGIOMA

*They are also called salmon patches or “stork marks”.

*Commonly involve the eyelids, glabella, or the nape of the neck.

*Pale pink in color and become prominent on crying.

*Most of them fade by one year of age.

📍MINIATURE PUBERTY 

*Miniature puberty is a cluster of clinical features, which can be seen during neonatal period, simulating pubertal secondary sexual characters. 

*It occurs due to the effect of maternal and placental hormones during foetal life. 

*The cluster of features include hyperpigmentation of linea nigra, scrotum, labia majora and/or nipples. 

*Scrotal hyperpigmentation and labial hypertrophy are the most common findings in miniature puberty .

*This pigmentation is common in newborns and may persist for two or three months.

*In female infants, by 3rd to 4th day of life there may be clitoral enlargement and/or transient vaginal bleeding with whitish or clear discharge.

*Enlargement of breast tissue with thick milk-like secretion (witch’s milk) may be seen.

 *If the secretion persist, then this can predispose to mastitis and/or breast abscess.

 *Engorged breast may occur in both male and female infants.

📍SUCKLING BLISTERS

*One or two solitary blisters or erosions are occasionally present at birth on the fingers, lips or forearm.

*Believed to be caused by vigorous sucking in utero ; hence the term sucking blister. 

*These heal rapidly without sequelae.

📍NEONATAL OCCIPITAL ALOPECIA

*The scalp hair is shed synchronously during the fifth month of fetal life, and when regrown enters telogen in a wave from front to back, starting about 12 weeks before term.

*After shedding of the telogen hairs from the frontal and parietal areas, the roots again enter the anagen phase in a similar wave from front to back.

*The roots in the occipital area do not enter telogen until term, and therefore alopecia may appear at this site at birth or within the first 2 months (neonatal occipital alopecia).

*Trauma from lying on this area may also contribute.

📍NEONATAL ACNE  

(NEONATAL CEPHALIC PUSTULOSIS)

*It is a transient condition of neonate, which is caused by influence of maternal hormones.

*Papules, pustules and comedones mainly on the face and occasionally the scalp is involved.

*Thought to be due to stimulation of sebaceous glands by maternal and endogenous androgens.

*No additional treatment is needed 

*Usually resolves spontaneously within four months without scarring.

📍LANUGO

*Newborns are covered with fine, unmedullated vellus hairs called lanugo. 

*Most prominent in preterm infants. 

*They are shed and replaced by vellus hairs during the first few months of life

📍EOSINOPHILIC PUSTULAR FOLLICULITIS OF INFANCY

( NEONATAL EOSINOPHILIC PUSTULOSIS)

*It is an uncommon entity with a mean age of onset at 6 months. 

*It is occasionally present at birth and almost always develops before 15 months of age.

*EPF of infancy is characterized by recurrent eruptions of sterile papules, pustules, and vesicles on an erythematous base. 

*Lesions are located primarily on the scalp but can also occur on the face.

*Spontaneous resolution by three years of age.

*Histologically, a dense eosinophilic infiltrate around follicles, within the outer root sheath.

*Symptomatic therapy including mid-potency topical corticosteroids, topical tacrolimus, and oral antihistamines.