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Baby Rashes 
1. The baby's skin 
2. Common skin problems 
3. How to treat and prevent 
4. Cases
-non living 
-replace every month 
- receptors 
(touch , heat, pain, pressure 
- starts to mature at 1st w OL. 
will continue to 
mature 6 months postnatal life 
- protection from trauma 
-heat storage 
-conserve calorie
B : skin epidermis is 1-2mm 
A : 2-3mm 
Thinner 
-absorb and hold watter better 
-fast water loss 
- temperature 
-microorganiss 
-humidity 
-external irritants 
- temperature 
-microorganiss 
-humidity 
-external irritants 
-sweat gland not fully develop 
(not able to fully 
regulate temperature) 
Not fully develop 
- 13% of body weight of neonate 
-3% of body weight in adult 
High body to surface area 
1/6 of adult 
PH 5.5 
- more sensitive to infection 
and irritation 
-Preterm infants have less collagen and elastin fibers in the dermis and are thus prone to edema. 
-Components of the dermal extracellular matrix in combination with the fetal environment and 
inflammatory response permit healing of skin wounds without scarring. This was first noted by surgeons 
involved in experimental fetal surgery. 
(Cohen & Siegfried, 2005; Dostal & Gamelli, 1993; Houska-Lund & Durand, 2006; Lund et al., 1999; Witt, 2004)
Infant Vs Adult 
1. structure 
- immaturity/ thinner/less hairy /less firm 
2. composition 
- relative high body surface area, 
elevated transepidermal water loss, 
protective flora is absent 
3. function 
- predispose to greater heat and fluid 
loss + drug / toxin absorption
When u see a skin rash.... 
- Characteristic of lesions / types 
(?papular/ macular? Vesicular? Red? 
Demarcation line? 
**m-p-v is primary lesion 
**scaling is 2dry lesion 
- Location, Distribution and progression 
- Timing of onset in relation to nonspecific 
sx
Common skin lesions 
- Macule: nonpalpable, circumscribed, flat lesion (<1 cm in diameter) 
- Papule: palpable , elevated lesion (<1 cm in diameter) 
- Maculopapular: combination of macular and popular lesions 
- Purpura: non-blanching papules or macules due to extravasation of 
RBCs 
- Vesicle: fluid-filled, elevated skin lesion (<1 cm in diameter) 
- Bulla: fluid-filled, elevated skin lesion (>1 cm in diameter) 
- Pustule: pus-containing vesicle 
- Ulcer: depressed skin lesion with missing epidermis and upper layer 
of dermis
Skin irritation ++ 
Candidiasis –very red with small red bumps 
(sometime pus filled) 
on outer edge 
require Rx antifungal cream 
1. clean + atmosphere 
2. hydration ! Hydration ! Mouisterizer !! 
Heat rash! 
(miliaria rubra)
Why heat rash happened? 
- Blockage of the pores that lead to the sweat 
glands / sweat retention cause by partial 
closure of the gland. 
- It is most common in very young children 
but can occur at any age, particularly in hot 
and humid weather. 
- An infant does not sweat. **immaturity of 
skin structure. 
- The sweat is held within the skin and forms 
little red bumps or occasionally small blisters. 
RX – cooling the room and moisturizer!!
Erythema Toxicum Neonatarum 
- Etiology : unknown 
- Most common pustular eruptions, macules & 
papules evolve into pustules, not involving palms and 
soles 
- Resembles Musquiote bites???? 
- Flat red splotches (usually with a white, pimple-like 
bump in the middle) 
-This rash rarely appears after 5 days of age, is 
usually gone in 7 - 14 days / Rx – not needed.
Resembles eczema but it does not itch!! 
-scaly/crusted/flay 
Appears at first 3mo 
Sharpyly demarcated 
Brightly erythematous 
Papulasqumous disorder 
Overactivity of the sebaceous gland 
(producing sebum)
Seborrheic dermatitis 
Ddx 
1. Eczema – red with 
scales 
2. Impetigo – infected 
plaques+itchy 
3. nappy rash/ candidiasis 
– location (perianal/groin) 
4. psoriasis ? Similar , 
can look similar 
in babies 
5.Fungal infections 
- eg, tinea 
Rx 
1. conservative 
(tar containing shampoo/ petrolatum/ soft brush) 
3.( may require aq cream/ steroid cr)
Eczema 
-Irritation of the skin 
-Dry, scaly, red (or darker than normal skin 
color), and itchy++ 
-When it goes on for a long time the areas 
become thickened. 
- Often associated with asthma and allergies, 
although it can often occur without either of 
these. 
- Eczema often runs in families 
- Rx ; steroid cream / tacrolimus (calcineurin 
inhibitors and work by modulating the 
immune response)
Acne Neonatarum 
-?? result from stimulation of sebaceous 
glands by maternal or infant androgens 
- resolve in 4-6 months 
- not requiring any topical rx 
- in some severe cases, may require topical 
benzyl peroxide
Observe and see! 
1. Is the rash red and scaly or red and non 
scaly? 
2. Are there pustules or blisters? Pus 
discharge? 
3. Is it a funny shape, colour or distribution?
Chicken Pox ( Varicella) 
1.Etiology : Varicella Zoster 
2. MOT : Airborne / contact 
3. Site : Face / scalp to trunkal 
4. Stages : contact - > * 
contagious ( 2-3 up to 5 days 
before rash(m-p-v appears) *dew 
drops on rose petal appearance*→ 
no more contagious when rash 
dry/ crusted 
6. incubation period 10-21days 
7. rx – 1)hydration 
2) analgesia 
3) cream/lotion
Measles ( Rubeola) 
Etiology ; rubeola virus 
MOT : airborne 
- droplets ( active for 2 hours on 
air) → incubation period 8-10d 
→ >sx shows 
*fever/cough/corya/conjuctivit 
is → 3-4d rash appears 
**blanching erythematous 
maculopapular 
**begins in head/neck and 
spreads centrifugally
Rubella 
● Etiology – Rubella Virus 
● MOT - contact/airborne 
● Uncommon now – MMR 
vaccine 
● Characteristic of 3days 
illness/rash dissapears 
● Ddx measles 
● sub occipital & posterior 
cervical 
lymphadenopathy
Hand Foot Mouth Disease 
● Etiology : Enterovirus genus 
( Picornaviridae family) 
(Coxsackie V A16 or 
Enterovirus 71 ; rare 
complications eg meningitis) 
● Stages – nonspe sx eg 
fever/LOA/sorethroat → 2-3d-- 
> rash appears ( macula-papular 
develops into vesicular) 
● Rx – symptomatic , analgesia + 
mouth wash
Reassurance!!! 
1. Use gentle, fragrance-free cleansers and soaps. 
Minimise usage of topical toxin and drugs 
2. Always moisturize 
3. Skin irritation / allergic reactions -> zinc oxide or titanium 
dioxide 
4. Wear protective clothing, such as a long-sleeved shirt, 
pants, a wide-brimmed hat and sunglasses, where possible. 
5. sunscreen! ( not recommended for < 6mo – try to avoid the 
sun!) 
6. consider bact/virus/fungal if present pustule/vesicular 
7. take ixs ( helpful! ) , smears and fluid culture

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Neonatal paediatric skin diseases

  • 1. Baby Rashes 1. The baby's skin 2. Common skin problems 3. How to treat and prevent 4. Cases
  • 2. -non living -replace every month - receptors (touch , heat, pain, pressure - starts to mature at 1st w OL. will continue to mature 6 months postnatal life - protection from trauma -heat storage -conserve calorie
  • 3. B : skin epidermis is 1-2mm A : 2-3mm Thinner -absorb and hold watter better -fast water loss - temperature -microorganiss -humidity -external irritants - temperature -microorganiss -humidity -external irritants -sweat gland not fully develop (not able to fully regulate temperature) Not fully develop - 13% of body weight of neonate -3% of body weight in adult High body to surface area 1/6 of adult PH 5.5 - more sensitive to infection and irritation -Preterm infants have less collagen and elastin fibers in the dermis and are thus prone to edema. -Components of the dermal extracellular matrix in combination with the fetal environment and inflammatory response permit healing of skin wounds without scarring. This was first noted by surgeons involved in experimental fetal surgery. (Cohen & Siegfried, 2005; Dostal & Gamelli, 1993; Houska-Lund & Durand, 2006; Lund et al., 1999; Witt, 2004)
  • 4. Infant Vs Adult 1. structure - immaturity/ thinner/less hairy /less firm 2. composition - relative high body surface area, elevated transepidermal water loss, protective flora is absent 3. function - predispose to greater heat and fluid loss + drug / toxin absorption
  • 5. When u see a skin rash.... - Characteristic of lesions / types (?papular/ macular? Vesicular? Red? Demarcation line? **m-p-v is primary lesion **scaling is 2dry lesion - Location, Distribution and progression - Timing of onset in relation to nonspecific sx
  • 6. Common skin lesions - Macule: nonpalpable, circumscribed, flat lesion (<1 cm in diameter) - Papule: palpable , elevated lesion (<1 cm in diameter) - Maculopapular: combination of macular and popular lesions - Purpura: non-blanching papules or macules due to extravasation of RBCs - Vesicle: fluid-filled, elevated skin lesion (<1 cm in diameter) - Bulla: fluid-filled, elevated skin lesion (>1 cm in diameter) - Pustule: pus-containing vesicle - Ulcer: depressed skin lesion with missing epidermis and upper layer of dermis
  • 7.
  • 8. Skin irritation ++ Candidiasis –very red with small red bumps (sometime pus filled) on outer edge require Rx antifungal cream 1. clean + atmosphere 2. hydration ! Hydration ! Mouisterizer !! Heat rash! (miliaria rubra)
  • 9.
  • 10. Why heat rash happened? - Blockage of the pores that lead to the sweat glands / sweat retention cause by partial closure of the gland. - It is most common in very young children but can occur at any age, particularly in hot and humid weather. - An infant does not sweat. **immaturity of skin structure. - The sweat is held within the skin and forms little red bumps or occasionally small blisters. RX – cooling the room and moisturizer!!
  • 11.
  • 12. Erythema Toxicum Neonatarum - Etiology : unknown - Most common pustular eruptions, macules & papules evolve into pustules, not involving palms and soles - Resembles Musquiote bites???? - Flat red splotches (usually with a white, pimple-like bump in the middle) -This rash rarely appears after 5 days of age, is usually gone in 7 - 14 days / Rx – not needed.
  • 13. Resembles eczema but it does not itch!! -scaly/crusted/flay Appears at first 3mo Sharpyly demarcated Brightly erythematous Papulasqumous disorder Overactivity of the sebaceous gland (producing sebum)
  • 14. Seborrheic dermatitis Ddx 1. Eczema – red with scales 2. Impetigo – infected plaques+itchy 3. nappy rash/ candidiasis – location (perianal/groin) 4. psoriasis ? Similar , can look similar in babies 5.Fungal infections - eg, tinea Rx 1. conservative (tar containing shampoo/ petrolatum/ soft brush) 3.( may require aq cream/ steroid cr)
  • 15.
  • 16. Eczema -Irritation of the skin -Dry, scaly, red (or darker than normal skin color), and itchy++ -When it goes on for a long time the areas become thickened. - Often associated with asthma and allergies, although it can often occur without either of these. - Eczema often runs in families - Rx ; steroid cream / tacrolimus (calcineurin inhibitors and work by modulating the immune response)
  • 17.
  • 18. Acne Neonatarum -?? result from stimulation of sebaceous glands by maternal or infant androgens - resolve in 4-6 months - not requiring any topical rx - in some severe cases, may require topical benzyl peroxide
  • 19.
  • 20. Observe and see! 1. Is the rash red and scaly or red and non scaly? 2. Are there pustules or blisters? Pus discharge? 3. Is it a funny shape, colour or distribution?
  • 21. Chicken Pox ( Varicella) 1.Etiology : Varicella Zoster 2. MOT : Airborne / contact 3. Site : Face / scalp to trunkal 4. Stages : contact - > * contagious ( 2-3 up to 5 days before rash(m-p-v appears) *dew drops on rose petal appearance*→ no more contagious when rash dry/ crusted 6. incubation period 10-21days 7. rx – 1)hydration 2) analgesia 3) cream/lotion
  • 22. Measles ( Rubeola) Etiology ; rubeola virus MOT : airborne - droplets ( active for 2 hours on air) → incubation period 8-10d → >sx shows *fever/cough/corya/conjuctivit is → 3-4d rash appears **blanching erythematous maculopapular **begins in head/neck and spreads centrifugally
  • 23. Rubella ● Etiology – Rubella Virus ● MOT - contact/airborne ● Uncommon now – MMR vaccine ● Characteristic of 3days illness/rash dissapears ● Ddx measles ● sub occipital & posterior cervical lymphadenopathy
  • 24. Hand Foot Mouth Disease ● Etiology : Enterovirus genus ( Picornaviridae family) (Coxsackie V A16 or Enterovirus 71 ; rare complications eg meningitis) ● Stages – nonspe sx eg fever/LOA/sorethroat → 2-3d-- > rash appears ( macula-papular develops into vesicular) ● Rx – symptomatic , analgesia + mouth wash
  • 25. Reassurance!!! 1. Use gentle, fragrance-free cleansers and soaps. Minimise usage of topical toxin and drugs 2. Always moisturize 3. Skin irritation / allergic reactions -> zinc oxide or titanium dioxide 4. Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible. 5. sunscreen! ( not recommended for < 6mo – try to avoid the sun!) 6. consider bact/virus/fungal if present pustule/vesicular 7. take ixs ( helpful! ) , smears and fluid culture