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Newborn Skin

Newborn Skin. Newborn skin is nearly half as thin as adult skin Weaker intercellular attachments Fewer eccrine and sebaceous gland secretions The stratum corneum in premature infants born before 32 weeks is markedly thinner than term infant skin, resulting in water loss. Care of Newborn Skin.

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Newborn Skin

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  1. Newborn Skin • Newborn skin is nearly half as thin as adult skin • Weaker intercellular attachments • Fewer eccrine and sebaceous gland secretions • The stratum corneum in premature infants born before 32 weeks is markedly thinner than term infant skin, resulting in water loss

  2. Care of Newborn Skin • Only water is really required for routine bathing by parents (all soaps mild irritants) • Bathe only once to twice a week • Avoid adhesives • Avoid excessive thermal and UV radiation

  3. Terminology

  4. Macule: Well circumscribed flat skin lesion that has a color change, size up to 1 cm (café au lait) Patch: Well circumscribed flat skin lesion that has a color change, size greater than 1 cm (Mongolian spot)

  5. Papule: Solid, raised lesion <1 cm in diameter (wart, milia) Plaque: Solid, raised lesion >1cm in diameter (nevus sebaceous)

  6. Vesicle: Elevated lesion < 1 cm containing clear, serous fluid (herpes simplex, varicella) Bulla: Elevated lesion >1 cm containing clear serous fluid (sucking bulla)

  7. Pustule: Vesicle >1cm containing purulent fluid (erythema toxicum)

  8. Ulcer: Full thickness loss of the epidermis with damage into the dermis

  9. Open Comedone: wide opening of the sebaceous follicle filled with plug of stratum corneum cells (black color from oxidized melanin)

  10. Closed Comedone: Obstruction just below the follicular opening with cystic swelling

  11. Transient Benign Lesions

  12. Erythema Toxicum Neonatorum • Papulovesicular lesions 1-2 mm in diameter with erythematous area around lesion • Located on trunk, arms and legs (not palms, soles) • Immaturity of the pilosebaceous follicles plays a role • Lesions contain eosinophils (at times neutrophils) • Affects 30-70% of all infants and noted 24 hours to 2 weeks after birth

  13. Transient Neonatal Pustular Melanosis • Superficial pustules or pigmented macules usually present at birth • May develop anywhere, especially over chin, neck, upper chest, lower back • Progresses from vesicopustules to scale to hyper-pigmentation • Cause is unknown • Pustules contain neutrophils • Noted in 4.4% of African American and 0.2% of European Americans

  14. Umbilical Granuloma • Pink papules that bleed easily and feel velvety • Presents when cord dries and falls off • Granulation tissue at the stump of the umbilical cord caused by incomplete healing • Treat with silver nitrate

  15. Miliaria • Caused by obstructed eccrine sweat ducts • Located on trunk, forehead, intertriginous and occluded areas • Heat and humidity play a role • Treatment is to avoid heat or occlusion • In warm climates may occur in 15% of infants • Miliaria crystallina--grouped vesicles from sweat trapped superficially

  16. Miliaria rubra grouped papules, pustules1-3 mm papules • Mimics neonatal infections such as Staph or HSV • Occlusion at the stratum corneum with extension deeper and subsequent inflammatory response

  17. Subcutaneous Fat Necrosis • Erythematous nodules or plaques • Located on cheeks or buttocks • Occur between days 1-7 of life • Cold injury may predispose • Usually resolve over several weeks, though may calcify

  18. Milia • White papules 1-2 mm in diameter • Located on nose, forehead, cheeks and when on palate are Epstein pearls • Superficial inclusion cysts • Occur in about 40% of infants • Resolve spontaneously in several months • Can puncture to diagnose revealing white ball of keratinous material

  19. Sebaceous Hyperplasia • Yellowish papules regularly spaced at the opening of each pilo-sebaceous follicle • Located on the nose and upper lip (location of high density of sebaceous glands) • Androgen stimulation causes proliferation • Occurs in 1/2 of newborns and resolves in weeks

  20. Acne Neonatorum • Inflammatory pustules and papules on the face • May be caused in response to Pityrosporum • Difficult to distinguish from miliaria rubra • May be present at birth, but often develop at 3-4 weeks of age and resolves spontaneously

  21. Infantile Acne • Comedones, papules or nodules • Located on the face and may cause scaring • Androgenic hormones play a role • Appearance identical to adult acne • Appears at two to three months • May use acne soaps, and if persist 5% benzoyl peroxide wash with care

  22. Vasomotor instability • Acrocyanosis-- the blue coloration that results from vasoconstriction of hands, feet, lips in response to cold • More common in premature infants

  23. Vasomotor instability • Mottling or cutis maromata results from the constriction of capillaries and venules in response to the cold (causes reticulated, mottled pattern)

  24. Vasomotor instability • Harlequin color change--caused by vasodilatation of dependent side, causing reversible erythema that lasts seconds to minutes • Onset 2-5 days of life • More common in premature infants • Lasts up to 3 weeks

  25. Desquamation • Normal newborn skin peels at 24-48 hours • Premature infants will not desquamate until 2-3 weeks of life • Post term infants crack and peel

  26. Sucking Blister • Bullous lesion • Located on any body part that can be sucked • Usually present at birth • Diagnose by placing the affected area close to the mouth • May require topical antibiotics

  27. Hyperpigmented Lesions

  28. Mongolian spots (Dermal Melanosis) • Macules or patches that are blue, gray, or black located on the buttocks • Collection of melanocytes in the dermis (perhaps error in migration of the pigmented cells) • Association between gangliosidosis and Mongolian spots • 90% of Native American, Asian, and African infants • Usually resolve spontaneously

  29. Dermal Melanosis • Dermal melanosis on shoulder called nevus of Ito (distribution of the posterior supraclavicular and lateral brachial cutaneous nerves • Dermal melanosis in the trigeminal nerve distribution called nevus of Ota (may be associated with glaucoma) • Both may require laser therapy

  30. Hyperpigmented lesions Café au lait • Oval tan brown macules 1.5-2cm located anywhere on the body • Found in 10% of European Americans and 22% of African Americans • Usually benign • Neurofibromatosis should be suspected if 6 or more café au lait macules • Large linear macules with jagged margin associated with McCune-Albright (polyostotic fibrous dysplasia, endocrine dysfunction, café au lait)

  31. Hyperpigmented lesionsCongenital Melanocytic Nevi • Tan to dark brown macules/plaques with or without hair • Proliferation of melanocytes in the skin at birth or the first months of life • Described as small (less than 1.5cm), intermediate (1.5-20cm), and large • Small nevi in 1-2% of newborns, intermediate 0.6%, large 0.2%

  32. Hyperpigmentation • Hyperpigmentation of scrotum, labia, areolae in response to maternal hormones • When located on lower abdomen it is called linea nigra • May be seen in congenital adrenal hyperplasia

  33. Vascular Lesions

  34. Vascular birthmarks • Nevus simplex, salmon patch • erythematous macules over glabella, nape (storkbite), eyelids (angel’s kisses) • vascular malformations of the capillaries • Most resolve by 3-6 months, but 1/4-1/2 of nape lesions persist • Incidence 70% of European descent, 59% of African descent, 22% Asian descent

  35. Port Wine Stains • Bright red macules present at birth caused by capillary malformations • Usually require laser to eliminate • Associated with syndromes

  36. Sturge Weber Syndrome • Port-wine stain in the distribution of the ophthalmic branch of the trigeminal nerve. • Associated with seizures (80%), mental retardation(60%), hemiplegia(30%) and neonatal glaucoma.3 • 5-8% of those with a port-wine stain in this distribution develop Sturge-Weber syndrome

  37. Klippel-Trénaunay-Weber Syndrome • Port-wine stain over extremity, with soft tissue and bony hypertrophy • In 1/4 of these patients, an arteriovenous fistula is present • Measure the length and girth of the extremity every three to six months • Imaging studies for AV fistula if elongation of an extremity is noted

  38. Hemangiomas • Most common vascular tumor of newbors • Benign tumor of endothelial cells • Occur in 1-3% of healthy newborns • May not be identified at birth (telangiectasia or erethema as precursors)

  39. Hemangiomas • More common in premature infants • more common in females • Proliferation in utero • Regress as infant ages (50% by 5, 70% by 7, 90% by 9)

  40. Hemangiomas • 65% are superficial and appear as bright red lesions • 15% are deeper in the dermis and are bluish in hue • The remainder are mixed

  41. Hemangiomas • Treatment required for: • airway obstruction • visual obstruction • thrombocytopenia due to platelet trapping (Kasabach-Merritt syndrome) • high output failure from systemic malformations • Prednisone 1-2mg/kg for 4-6 weeks

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