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Sample chapter Skin Disease 3e by Habif

Sample chapter Skin Disease 3e by Habif

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Sample chapter skin disease 3e by habif. to order call-sms at +91 8527622422 Document Transcript

  • 1. 21 Neonatal disease Erythema Toxicum ■ Individual lesions can disappear in hours Neonatorum or last for up to 2 weeks. Description Non-skin Findings ■ Erythema toxicum neonatorum is a ■ There are no signs of systemic illness. common benign transient pustular eruption seen in the newborn period. Laboratory and Biopsy ■ A smear (Wright’s or Giemsa stain) of History pustule fluid shows abundant eosinophils ■ Erythema toxicum neonatorum occurs with relatively few neutrophils. more commonly in healthy term infants ■ For atypical cases a skin biopsy can be than in premature and low birth weight done, showing subcorneal pustules with infants. eosinophils. ■ The cause of erythema toxicum neonatorum is unknown. Differential Diagnosis ■ Bacterial infection (Staphylococcus Skin Findings aureus, group B Streptococcus, ■ Erythema toxicum neonatorum lesions Pseudomonas aeruginosa, Listeria appear as “blotchy” macules that monocytogenes, Haemophilus develop into superficial pink papules influenzae, Klebsiella pneumoniae) and pustules, taking on a “flea-bitten” ■ Fungal infection (Candida) appearance. ■ Viral infection (herpes simplex, varicella) ■ Macules can coalesce to form large pink ■ Transient neonatal pustular melanosis patches studded with only a few to ■ Scabies hundreds of pustules. ■ Erythema toxicum neonatorum can Course and Prognosis occur anywhere on the skin, but the ■ Erythema toxicum neonatorum resolves face, arms, buttocks, and torso are most within 3 weeks of life, without any frequently involved. The palms and soles adverse sequelae. are rarely affected. ■ Overall, erythema toxicum neonatorum Treatment can wax and wane with individual ■ No required treatment. lesions appearing to occur in crops. ■ Parents should be reassured. Skin Disease. © 2011 Elsevier Inc. All rights reserved. 590CH021.indd 590 4/14/2011 6:17:44 PM
  • 2. Miliaria 21 Cutis Marmorata Laboratory and Biopsy Description ■ No laboratory testing or biopsy is ■ Cutis marmorata is a transient benign required. mottling of the skin that resolves with re-warming. Differential Diagnosis ■ Cutis marmorata telangiectatica History congenita is a rare vascular ■ Cutis marmorata is a common and normal malformation, showing a reticulated vascular reaction pattern that is seen in vascular pattern with dermal atrophy both full-term and preterm infants. ■ Livedo reticularis is the cutis marmorata- ■ Infants with Down syndrome, trisomy like pattern seen in neonatal lupus 18, hypothyroidism, neonatal lupus, and septic shock can develop vascular Treatment ■ Re-warming results in complete mottling that does not resolve with re-warming. resolution of the erythema. ■ Parents should be reassured. ■ Cutis marmorata is thought to be due to an exaggerated vasomotor response to decreased core body temperature. Skin Findings ■ Cutis marmorata manifests as blanching mottled or lace-like erythema that resolves with re-warming. ■ It occurs on the trunk and extremities. 591CH021.indd 591 4/14/2011 6:17:44 PM
  • 3. Neonatal disease Miliaria intertriginous areas such as the neck Description folds. Other common sites include the ■ Miliaria is the term describing clear to face (especially the forehead) and trunk. red papules (miliaria crystallina, miliaria ■ Miliaria crystallina is characterized by rubra, miliaria profunda) that result from multiple subtle “dew drop” vesicles. obstruction of the eccrine sweat duct. These vesicles are very superficial and break easily with gentle friction. History ■ Miliaria rubra is characterized by non- ■ Miliaria is very common in newborns and follicular pustules and vesicles. infants who are “bundled” or placed in ■ Miliaria profunda is characterized by warm environments. small non-erythematous papules and ■ In newborns, miliaria crystallina is pustules, occurring on the trunk and the most common type and is due to extremities. obstruction of the eccrine duct at the level of the stratum corneum. Warming Non-skin Findings lights and tight bundling can produce ■ Febrile infants are at risk for developing miliaria crystallina. miliaria. ■ Miliaria rubra (“prickly heat” or “heat rash”) is due to obstruction of the Laboratory and Biopsy ■ Generally, skin biopsy is not intraepidermal eccrine duct, producing necessary. leakage of sweat around the duct, and release of local inflammatory mediators. Differential Diagnosis Miliaria rubra affects infants older than 1 ■ Erythema toxicum neonatorum week of age. ■ Candidiasis ■ Miliaria profunda is due to eccrine duct ■ Insect bites obstruction at the dermal–epidermal junction and is rarely seen in newborns. Course and Prognosis ■ The cause of miliaria is not known, ■ Miliaria lasts for hours or days. although a polysaccharide produced by certain strains of Staphylococcus Treatment ■ No treatment is necessary other than epidermidis may play a role in obstruction of the eccrine duct. a cool bath and avoidance of tight bundling. Skin Findings ■ Miliaria crystallina and miliaria rubra show marked involvement of 592CH021.indd 592 4/14/2011 6:17:44 PM
  • 4. Cutis Marmorata 21 Miliaria crystallina is the most common type of miliaria, and is due to obstruction of the eccrine duct at the level of the stratum corneum. Miliaria rubra (“prickly heat” or “heat rash”) is due to obstruction of the intraepidermal eccrine duct, producing leakage of sweat around the duct, and release of local inflammatory mediators. 593CH021.indd 593 4/14/2011 6:17:44 PM