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Neonatal skin rashes
- 2. Outline • Vascular skin lesions • pigmented skin lesions • Vesicopustular skin lesions • Febrile skin lesions
- 3. introduction • Rashes are common in newborn, and they can be source of significant source of parental concern • Most of them are transient and benign, some of them require work up
- 4. Infantile hemangioma • They are benign vascular tumors • Occur in 5-10% of newborns • Are common in preterm and have a female predominance • They don’t appear directly after birth • They are treated with prednisolone and propranolol • They disappear at 7 years in 76%
- 6. Dermal melanocytosis (Mongolian spot) • They involve the lumbosacral area • Appear at birth or soon after birth • Most disappear in childhood • Naevus of ito (upper back&shoulder) persist • Are caused by sparse melanocyte in mid to low dermis
- 7. Erythema toxicum neonatorum • Occur in 40% to 70% newborn, most in term, normal weight newborn, • In 2 and 3 day mostly • Lesions are erythematous 2-3mm, macule&papule that develop into pustules surrounded by erythema • Flea bite appearance • Face, trunk, but not palms and sore • Lesions fade in 5-7 days, may reoccur
- 8. Transient neonatal pustular melanosis • It occur in 5% of black new born, • Rare in white • Its lesions lack surrounding erythema • Lesions rupture easily leaving a pigmented macule that fade over 3-4 weeks • Involve all the body including sole and palm
- 9. Acne neonatorum • Closed comedones on forehead, nose and cheek, • Papules and pustules can also develop • Occur in 20% of newborns • Are due to stimulation of sebaceous gland • Lesions resolve spontaneously within 4 months without scaling • If severe: 2.5% benzoyl peroxide
- 10. Milia • Are 1-2mm white or yellow papule due to keratin retention in dermis • Occur in 50% of newborn • Mostly found on forehead, cheeks, nose and chin Usually, Resolve spontaneously in 1 month, may go to 3 months
- 11. Miliaria • They result from sweat retention caused by partial obstruction of eccrine gland • Both miliaria and milia are due to immaturity of skin Miliaria affect 40% of newborn in first month of life Treatment: avoid overheating of newborn’s body
- 12. Saborrheic dermatitis • Characterized by erythema and greasy scales • Mostly on scalp “cradle cap” • May attack ear, neck, face • Erythema in flexural folds and intertriginous area, to consider diaper dermatitis and mostly Scaling on the scalp, • Causes: malassezia furfur, hormonal fluctuation, immunodeficiency
- 13. Saborrheic dermatitis cont’’’ • Treatment: white petroleum, tar-containing shampoo, ketoconazole 2% shampoo or 2%cream hydrocortisone 1% cream (rash in flexural area)
- 14. Varicella • The rash typically lasts 12 to 21 days. • Patients remain contagious until the last lesion has completely crusted over.
- 15. Varicella lesions on the palate
- 16. Varicella: lesions of different ages on the same area of skin
- 17. HERPES ZOSTER • Herpes simplex type 1 (HSV-1) • cold sores • fever blisters • Herpes simplex type 2 (HSV-2) • genital herpes
- 18. Vesicles in Herpes simplex
- 19. IMPETIGO • Caused by Streptococcus pyogenes or Staphylococcus aureus. • Impetigo presents with pustules
- 20. Impetigo
- 21. Bullous impetigo
- 22. Take home message • Infants who are sick looking with vesicopustular rashes should be tested for bacterial, viral and fungal infection • Acne neonatorum usually resolve within 4 months, in severe cases we can use 2.5% benzoyl peroxide to fasten the resolution • Miliaria rubra respond to prevention of overheating by: cool bath, air conditioning, removal of excess clothing • Infantile seborrheic dermatitis usually respond to conservative treatment by petrolatum, tar-containing shampoo, • Topic Anti-fungal and mild corticosteroids are used in resistant cases.
- 23. Reference • American family physician, Vol 77, No.1, Jan 1,2008 • Notes of prof Muganga • Australia Family physician ,Vol 41,No.5, May 2012
- 25. Outline • Vascular skin lesions • pigmented skin lesions • Vesico pustular skin lesions • Febrile skin lesions
- 26. introduction • Rashes are common in newborn, and they can be source of significant source of parental concern • Most of them are transient and benign, some of them require work up
- 27. Infantile hemangioma • They are benign vascular tumors • Occur in 5-10% of newborns • Are common in preterm and have a female predominance • They don’t appear directly after birth • They are treated with prednisolone and propranolol • They disappear at 7 years in 76%
- 29. Dermal melanocytosis (Mongolian spot) • They involve the lumbosacral area • Appear at birth or soon after birth • Most disappear in childhood • Naevus of ito (upper back&shoulder) persist • Are caused by sparse melanocyte in mid to low dermis
- 30. Erythema toxicum neonatorum • Occur in 40% to 70% newborn, most in term, normal wait newborn, • In 2 and 3 day mostly • Lesions are erythematous 2-3mm, macule&papule that develop into pustules surrounded by erythema • Flea bite appearance • Face, trunk, but not palms and sore • Lesions fade in 5-7 days, may reoccur
- 31. Transient neonatal pustular melanosis • It occur in 5% of black new born, • Rare in white • Its lesions lack surrounding erythema • Lesions rupture easily leaving a pigmented macule that fade over 3-4 weeks • Involve all the body including sole and palm
- 32. Acne neonatorum • Closed comedones on forehead, nose and cheek, • Papules and pustules can also develop • Occur in 20% of newborns • Are due to stimulation of sebaceous gland • Lesions resolve spontaneously within 4 months without scaling • If severe: 2.5% benzoyl peroxide
- 33. Milia • Are 1-2mm white or yellow papule due to keratin retention in dermis • Occur in 50% of newborn • Mostly found on forehead, cheeks, nose and chin Usually, Resolve spontaneously in 1 month, may go to 3 months
- 34. Miliaria • They result from sweat retention caused by partial obstruction of eccrine gland • Both miliaria and milia are due to immaturity of skin Miliaria affect 40% of newborn in first month of life Treatment: avoid overheating of newborn’s body
- 35. Saborrheic dermatitis • Characterized by erythema and greasy scales • Mostly on scalp “cradle cap” • May attack ear, neck, face • Erythema in flexural folds and intertriginous area, to consider diaper dermatitis and mostly Scaling on the scalp, • Causes: malassezia furfur, hormonal fluctuation, immunodeficiency
- 36. Saborrheic dermatitis cont’’’ • Treatment: white petroleum, tar-containing shampoo, ketoconazole 2% shampoo or 2%cream hydrocortisone 1% cream (rash in flexural area)
- 37. Varicella • The rash typically lasts 12 to 21 days. • Patients remain contagious until the last lesion has completely crusted over.
- 38. Varicella lesions on the palate
- 39. Varicella: lesions of different ages on the same area of skin
- 40. HERPES ZOSTER • Herpes simplex type 1 (HSV-1) • cold sores • fever blisters • Herpes simplex type 2 (HSV-2) • genital herpes
- 41. Vesicles in Herpes simplex
- 42. IMPETIGO • Caused by Streptococcus pyogenes or Staphylococcus aureus. • Impetigo presents with pustules
- 43. Impetigo
- 44. Bullous impetigo
- 45. Take home message • Infants who are sick looking with vesicopustular rashes should be tested for bacterial, viral and fungal infection • Acne neonatorum usually resolve within 4 months, in severe cases we can use 2.5% benzoyl peroxide to fasten the resolution • Miliaria rubra respond to prevention of overheating by: cool bath, air conditioning, removal of excess clothing • Infantile seborrheic dermatitis usually respond to conservative treatment by petrolatum, tar-containing shampoo, • Topic Anti-fungal and mild corticosteroids are used in resistant cases.
- 46. Reference • American family physician, Vol 77, No.1, Jan 1,2008 • Notes of prof Muganga • Australia Family physician ,Vol 41,No.5, May 2012
Editor's Notes
- cold sores , fever blisters = boutons de chaleur
- Boutons de fievre (“cold sores”) due to Herpes
- cold sores , fever blisters = boutons de chaleur
- Boutons de fievre (“cold sores”) due to Herpes