SKIN DISEASE OF THE NEWBORN

Milia

MILIA AND BABY ACNE

These commonly occur on the face and scalp, and consist of tiny white papules which are usually discrete.  They can however occur anywhere, and may be present at birth or appear subsequently.  They usually resolve within a few months without treatment.

Milia are inclusion cysts which contain trapped keratinised stratum corneum.  They may rarely be associated with other abnormalities in syndromes including epidermolysis bullosa and the oro-facial-digital syndrome (type 1).

Similar lesions may be seen in the mouth in some infants.  When on the hard palate, they are referred to as Epstein’s pearls; when on the alveolar ridges, they are called alveolar cysts or Bohn’s nodules.

 

Mongolian spot

Blue-gray spots, commonly referred to as Mongolian spots, are large flat lesions that are usually found on the lower back or buttocks of infants at birth. They can occasionally be found on the legs or shoulders of infants, but this is less common. The color of blue-gray spots ranges from deep brown to slate gray or blue-black. They are caused by collections of pigment-producing cells (melanocytes) located in a deeper layer in the skin and are the most common type of birthmark.

The photos show a typical Mongolian spot with bluish discoloration.

This is a very common benign skin pigmentation occurring frequently in Polynesian, Asian and Mediterranean babies but also, though to a much lesser extent, in Europeans.

Although the intergluteal area is the most common site, similar lesions may occur over the trunk or extremeties and at times multiple lesions may be noted. Such lesions have been confused for bruises of child abuse. They gradually fade during the first few years of life

Picture of Mongolian Spot (Blue-Gray Spot) on the hand 

 

 

Sucking Blisters

These lesions are present at birth, most often over the dorsal and lateral aspect of the wrist. They may appear like well demarcated bruises or they may be vesicular. They can be either bilateral or unilateral. Less often, they may be noted more proximally in the forearm. The infant is noted to exhibit excessive sucking activity. The absence of lesions in other parts of the body and the otherwise well appearance of the infant would rule out pathological disorders presenting with similar lesions.

In the lower image, the blister present on the dorsal surface of the second finger burst open discharging yellow serous fluid. Such a lesion may be confused with bullous impetigo but the time of onset, the location and the examination should differentiate the two.

 

Benign Pustular Melanosis of the Newborn

Lesions are present at birth and are characterised by superficial pustules which rupture easily without any actual pus content, leaving a spot of hyperpigmentation. Some hyperpigmented lesions may be present at birth. Any area of the body may be involved. The pustules last for a day or two but the pigmented spots may persist for a long time. Aetiology is unknown. Smears from the pustules reveal polymorphonuclear leukocytes with absence of organisms.

In the image to the left, this baby’s rash appeared on the second day of life which is atypical for this condition. The pustules were profuse, covering almost the entire body. Note very early pigmentation at around 1 o’clock. Wright stain from one lesion revealed neutrophils and no organisms.

Nappy Rash (Diaper Dermatitis)

Nappy rash is a common problem for neonates within the first few months of life. Whilst the exact aetiology of nappy rash is not clear, it is felt to be due to moisture in the nappy environment and from irritation from urine and stool. Many infants will be affected by superinfection with Candida albicans.

Typically in Candidal nappy rash, there is erythema in the perineal region, with satellite lesions which may coalesce. There is often an appearance of scale. In the images to the left from the same baby, satellite lesions are seen. Note that there are some lesions close to the umbilicus and extending around the flank. Swabs were positive for Candida.

Treatment primarily involves the use of a topical agent such as nystatin or miconazole. There should be liberal use of barrier creams, and soiled and wet nappies should be changed promptly. Oral nystatin may be used in conjunction with topical treatment, although this may not improve resolution. Occasionally, in severe cases, a mild topical steroid may be needed.

Conditions that need to be considered in the differential diagnosis include psoriasis, contact or irritant dermatitis, and zinc deficiency.

 

Neonatal acne

Neonatal acne may be present at birth, or develop over the first 2-4 weeks of life.  There is controversy over whether it is truly acne or whether it represents a form of pustular disorder in the newborn period.  As a result, the term neonatal cephalic pustulosis has been mooted.

The condition consists of pustules over the cheeks primarily, but also involves other areas of the face and the scalp.  As opposed to infantile acne (which develops after 2 months) and acne of adolescence, there are no comedomes in the neonatal form.  It may be difficult to differentiate between acne and miliaria rubra.

Neonatal acne resolves spontaneously and without scarring.

Seborrhoeic dermatitis

Seborrhoeic dermatitis primarily affects the scalp and intertriginous areas. It is most common in the first 6 weeks of life, but can occur in children up to 12 months of age.  Involvement of the scalp is frequently termed “cradle cap”, and manifests as greasy, yellow plaques on the scalp.  Other commonly affected areas include the forehead and eyebrows (as in the photo to the left), nasolabial folds, and external ears.  Involvement of skin creases, such as the nappy area, can lead to secondary Candidal infection and maceration.

The aetiology is unknown.  Treatment includes the use of a mild tar shampoo, oatmeal baths, and avoidance of soaps.  Occasionally, a mild topical steroid may be indicated.

Miliaria

Miliaria is due to obstruction of sweat and rupture of the exxrine sweat duct.  It is commonly seen secondary to thermal stress, particularly with crops of lesions over the face, scalp, and trunk. In neonates, there are two forms:

  1. Miliaria crystallina (see image to the left), in which there are superficial vesicles which are 1-2mm in diameter.  The skin does not appear inflamed.
  1. Miliaria rubra (also called “prickly heat”) results in papules and pustules from obstruction in the mid-epidermis.

It is important to ensure that the baby is not over-wrapped, and once the heat stress is removed the lesions usually resolve quickly.

Erythema Toxicum Neonatorum

 Onset in the second to third day of life, mostly in term babies of lesions characterised by a central whitish to yellowish papule surrounded by a halo of erythema, mainly over the trunk but also in the limbs and face. Lesions may intensify or coalesce particularly in response to local heat. They wax and wane over the ensuing 3 to 6 days. They are benign. Aetiology is unknown.

 

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Gianotti-Crosti Syndrome

REPORT OF A CASE

A 22-month old boy was brought to the University Pediatric Dermatology clinic by his parents for evaluation of a progressive erythematous eruption of 3 weeks duration. The rash was asymptomatic and the child was otherwise well with no history of a preceding fever or upper respiratory tract infection. No other family members were affected. The eruption consisted of erythematous 1-4mm papules over his face, trunk and extremities. The midline area of his chest and abdomen showed only minimal involvement, while the lateral aspects of his trunk were markedly involved and showed coalescence of the papules into raised geographic plaques. Cervical lymphadenopathy was present.
Laboratory evaluation revealed a slight elevation of serum LDH and alkaline phosphatase. The total white blood cell count was normal with a slight lymphocytosis.
A biopsy was taken from an involved area on his trunk.Laboratory evaluation revealed a slight elevation of serum LDH and alkaline phosphatase. The total white blood cell count was normal with a slight lymphocytosis.

A biopsy was taken from an involved area on his trunk.

CLINICAL COURSE: Serologic evaluation was performed for a variety of viruses and revealed a high titer of antibodies to certain components of the Epstein-Barr virus panel consistent with recent infection. On follow up examination one week later his eruption had almost completely cleared.

DISCUSSION: Gianotti-Crosti syndrome is a reactive exanthem that can appear following infection by a number of different viruses. It was first described in association with Hepatitis B infection by Gianotti in 1955.1 Since then, it has been associated with many viruses including Epstein-Barr virus,2 coxsackie virus,3 parainfluenza virus4 and cytomegalovirus,3 among others. It is most commonly seen in children aged 2-6 years and is characterized by the predominantly acral distribution of non-pruritic erythematous papules or papulovesicles in an otherwise healthy child. Frequently, parents will relate the occurrence of upper respiratory tract symptoms preceding the onset of the rash. Lymphadenopathy is often present and hepatomegaly, although less common, can also be seen. The exanthem typically resolves in 3-5 weeks without treatment. Our patient’s clinical presentation was somewhat unusual; his eruption was most extensive over the trunk, an area that is typically spared or shows only minimal involvement. Laboratory evaluation often reveals a mild lymphocytosis (54-73%) and transient elevations of liver enzymes can be present even in the absence of Hepatitis B infection. 4 The histopathologic changes include a superficial or superficial and deep lymphocytic perivascular infiltrate. In older lesions the infiltrate may become interstitial. Spongiosis is uniformly present and may become so extensive that spongiotic vesicles are formed. Edema of the papillary dermis is often profound.

Because of the association with known viruses, it is essential to perform appropriate serologic tests. Hepatitis B, in particular may be present without any other signs or symptoms of infection. Serologic testing in our patient revealed a recent infection with EBV.

 

 

REFERENCES

1 Gianotti F. Rilievi di una particolare casistica tossinfettiva caratterizzata de eruzione eritemato-infiltrativa desquamativa a focolai lenticolari, a sede elettiva acroesposta. G Ital Dermatol 1955;96:678-97.

2 Lowe L, Hebert AA, Duvic M. Gianotti-Crosti syndrome associated with Epstein-Barr virus infection. J Am Acad Dermatol 1989; 20:336-8.

3 Taieb A, Plantin P, du Pasquier P, et al. Gianotti-Crosti syndrome: a study of 26 cases. Br J Dermatol 1986;115:49-59.

4 Spear KL, Winkelmann RK. Gianotti-Crosti Syndrome. Arch Dermatol 1984:1120:891-896.

 

source : http://dermatology.cdlib.org/

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CLINICAL PEDIATRIC ONLINE 

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JL Taman Bendungan Asahan 5 Jakarta Indonesia

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http://clinicalpediatric.wordpress.com/

 

 

Clinical and Editor in Chief :

WIDODO JUDARWANTO

email : judarwanto@gmail.com,

 

Copyright © 2009, Clinical Pediatric Online Information Education Network. All rights reserved.

DISEASE AND RESOURCE

Acne : Acne Support Group
Albinism : National Organization for Albinism and Hypopigmentation
Alopecia Areata : Alopecia Areata (links)
Ataxia – Telangiectasia: Children’s Project
Atopic Dermatitis : The Atopic Dermatitis Information Server
Behcet’s disease : American Behcet’s Disease Association

Bloom’s syndrome : Bloom’s syndrome Registry
Dermatitis Herpetiformis : The Gluten – free Links Page
Dermatomyositis – Polyomyositis :
Muscular Dystrophy Association – USA
Ectodermal dysplasias : National Foundation for Ectodermal Dysplasias
Eczema : National Eczema Society
Ehlers Danlos syndrome : The Ehlers-Danlos National Foundation (EDNF)
Epidermolysis Bullosa : National Epidermolysis Bullosa Registry (NEBR)
Giant Congenital Nevi : Nevus Network , The Giant Nevus Association Page
Hair loss : American Hair Loss Online Brochures, The Baldman’s Home Page
Hemangiomata : Hemangioma And Vascular Birthmark Foundation
Herpes Simplex :
Herpes Zone
Hyperhidrosis : Hyperhidrosis, The Center for Hyperhidrosis
Incontinentia Pigmenti : National Incontinentia Pigmenti Foundation – USA
Kaposi’s Sarcoma : Kaposi’s Sarcoma Page (Oncolink, Univ. of Pensylvania)
Kawasaki syndrome : Kawasaki Families’ Network and Kawasaki disease Photo’s
Klippel-Trenaunay syndrome :
Klippel-Trenaunay Syndrome Support Group
Latex allergy : Latex Allergy
Leprosy : Leprosy Home Page at WHO
Lupus Erythematosus : Lupus Home Page
Lyme disease : Lyme Disease Foundation, Information Resource and NetworkMastocytosis : Mastocytosis Society
Melanoma : Melanoma Home Page, Melanoma Zone and Melanoma Patients’ Information Page
Neurofibromatosis : National Neurofibromatosis Foundation
Parasitoses : Cutaneous Parasite Home Page
Pediculosis (Lice) : National Pediculosis Association , American Head Lice Information Center
Pemphigus : The National Pemphigus Foundation
Pityriasis Rubra Pilaris :
Pityriasis Rubra Pilaris
Pseudofolliculitis Barbae (PFB) :
PFB Sufferers of America PseudoxanthomaElasticum:Pseudoxanthoma elasticum
Psoriasis : National Psoriasis Foundation – USA
Porphyria : American Porphyria Foundation
Port Wine Stains : Port Wine Stain Web Site Home Page
Rosacea : National Rosacea Society – USA
Scleroderma : Scleroderma from A to Z
Sjogren’s syndrome : Sjogren’s Syndrome foundation page
Skin Cancers : The Skin Cancer Foundation
Stevens Johnson Syndrome :
Stevens Johnson Syndrome Foundation
Sturge Weber syndrome :
Sturge Weber Foundation
Tuberous Sclerosis : National Tuberous Sclerosis Association – USA
Turner’s syndrome : The Turner’s syndrome society of US
Vitiligo : National Vitiligo Foundation (USA)
Xeroderma Pigmentosum : Xeroderma Pigmentosum Society

 

 

Supported  by
CLINICAL PEDIATRIC ONLINE

Yudhasmara Foundation

mail : JL Taman Bendungan Asahan 5 Jakarta Indonesia 10210

phone : 62(021) 70081995 – 5703646

email : judarwanto@gmail.com,

http://clinicalpediatric.wordpress.com/

 

 

 

Editor in Chief :

Dr WIDODO JUDARWANTO

email : judarwanto@gmail.com

 

 

Copyright © 2009, Clinical Pediatric Online Information Education Network. All rights reserved.

 

 

DISEASE AND CONDITION

 
 
 

Parasitic Infections

 

Supported  by
CLINIC FOR CHILDREN

Yudhasmara Foundation

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646

http://childrenclinic.wordpress.com/

 

 

 

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

email : judarwanto@gmail.com

 

 

 

 

 

 

 

Copyright © 2009, Clinic For Children Information Education Network. All rights reserved.

PEDIATRIC DERMATOLODY : DISEASE AND CONDITION

 

 

Supported  by
CLINIC FOR CHILDREN

Yudhasmara Foundation

JL Taman Bendungan Asahan 5 Jakarta Indonesia 102010

phone : 62(021) 70081995 – 5703646

http://childrenclinic.wordpress.com/

 

 

 

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO

email : judarwanto@gmail.com

 

 

 

 

 

 

 

Copyright © 2009, Clinic For Children Information Education Network. All rights reserved.

REFERENCE – BIBLIOGRAPHY IN DIAPERS DERMATITIS

References

  1. Berg RW, Milligan MC, Sarbaugh FC. Association of skin wetness and pH with diaper dermatitis. Pediatr Dermatol. Mar 1994;11(1):18-20. [Medline].
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  3. Collipp PJ, Kuo B, Castro-Magana M, et al. Hair zinc, scalp hair quantity, and diaper rash in normal infants. Cutis. Jan 1985;35(1):66-70. [Medline].
  4. Darmstadt GL, Dinulos JG. Neonatal skin care. Pediatr Clin North Am. Aug 2000;47(4):757-82. [Medline].
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  7. Higuchi R, Mizukoshi M, Koyama H, et al. Intractable diaper dermatitis as an early sign of biotin deficiency. Acta Paediatr. Feb 1998;87(2):228-9. [Medline].
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Supported  by
CLINIC FOR CHILDREN

Yudhasmara Foundation

Office ; JL Taman Bendungan Asahan 5 Jakarta Indonesia 10210

phone : 62(021) 70081995 – 5703646

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http://childrenclinic.wordpress.com/

 

 

 

Editor in Chief :

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email : judarwanto@gmail.com

 

 

Copyright © 2009, Clinic For Children Information Education Network. All rights reserved.

REFERENCE AND BIBLIOGRAPHY IN ATOPIC DERMATITIS

  1. Ong PY, Leung DY. Immune dysregulation in atopic dermatitis. Curr Allergy Asthma Rep. Sep 2006;6(5):384-9. [Medline].
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  3. Ong PY, Boguniewicz M. Atopic dermatitis. Prim Care. Mar 2008;35(1):105-17, vii. [Medline].
  4. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venreol. 1980;92:44-7.
  5. Chamlin SL, Kao J, Frieden IJ, et al. Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: changes in barrier function provide a sensitive indicator of disease activity. J Am Acad Dermatol. Aug 2002;47(2):198-208. [Medline].
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  7. Greer FR, Sicherer SH, Burks AW. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. Jan 2008;121(1):183-91. [Medline].
  8. Bukutu C, Deol J, Shamseer L, Vohra S. Complementary, holistic, and integrative medicine: atopic dermatitis. Pediatr Rev. Dec 2007;28(12):e87-94. [Medline].
  9. Patel TS, Greer SC, Skinner RB Jr. Cancer concerns with topical immunomodulators in atopic dermatitis: overview of data and recommendations to clinicians. Am J Clin Dermatol. 2007;8(4):189-94. [Medline].
  10. Ring J, Mohrenschlager M, Henkel V. The US FDA ‘black box’ warning for topical calcineurin inhibitors: an ongoing controversy. Drug Saf. 2008;31(3):185-98. [Medline].
  11. Boguniewicz M. Topical treatment of atopic dermatitis. Immunol Allergy Clin North Am. Nov 2004;24(4):631-44, vi-vii. [Medline].
  12. Beltrani VS. Atopic dermatitis: An update. J Allergy Clin Immunol. Sep 1999;104(3 Pt 2):S85-6. [Medline].
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  14. Boguniewicz M. Topical treatment of atopic dermatitis. Immunol Allergy Clin North Am. Nov 2004;4:631-44. [Medline].
  15. Drake L, Prendergast M, Maher R, et al. The impact of tacrolimus ointment on health-related quality of life of adult and pediatric patients with atopic dermatitis. J Am Acad Dermatol. Jan 2001;44(1 Suppl):S65-72. [Medline].
  16. Drake LA, Ceilley RI, Cornelison RL, et al. Guidelines of care for nevi I (nevocellular nevi and seborrheic keratoses). Committee on Guidelines of Care. Task Force on Nevocellular Nevi. J Am Acad Dermatol. Apr 1992;26(4):629-31. [Medline].
  17. Eichenfield LF, Lucky AW, Boguniewicz M. Safety and efficacy of pimecrolimus (ASM 981) cream 1% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol. Apr 2002;46(4):495-504. [Medline].
  18. Gdalevich M, Mimouni D, David M, Mimouni M. Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies. J Am Acad Dermatol. Oct 2001;45(4):520-527. [Medline].
  19. Grundmann-Kollmann M, Kaufmann R, Zollner TM. Treatment of atopic dermatitis with mycophenolate mofetil. Br J Dermatol. Aug 2001;145(2):351-2. [Medline].
  20. Gutman ab, Kligman am, Sciacca j, James WD. Soak and smear: A standard technique revisited. Arch Dermatol. 2005;141:1556-9. [Medline].
  21. Halbert AR, Weston WL, Morelli JG. Atopic dermatitis: is it an allergic disease?. J Am Acad Dermatol. Dec 1995;33(6):1008-18. [Medline].
  22. Hamzavi I, Lui H. Using light in dermatology: an update on lasers, ultraviolet phototherapy, and photodynamic therapy. Dermatol Clin. Apr 2005;23(2):199-207. [Medline].
  23. Hanifin JM, Tofte SJ. Update on therapy of atopic dermatitis. J Allergy Clin Immunol. Sep 1999;104(3 Pt 2):S123-5. [Medline].
  24. Ho VC, Gupta A, Kaufmann R, et al. Safety and efficacy of nonsteroid pimecrolimus cream 1% in the treatment of atopic dermatitis in infants. J Pediatr. Feb 2003;142(2):155-62. [Medline].
  25. Hurwitz S. Eczematous eruptions in childhood. In: Clinical Pediatric Dermatology: A Textbook of Skin Disorders of Childhood and Adolescence. 2nd ed. Philadelphia, PA: WB Saunders Co; 1993:45-60.
  26. Kang S, Lucky AW, Pariser D, et al. Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children. J Am Acad Dermatol. Jan 2001;44(1 Suppl):S58-64. [Medline].
  27. Knoell KA, Greer KE. Atopic dermatitis. Pediatr Rev. Feb 1999;20(2):46-51; quiz 52. [Medline].
  28. Krutmann J, Diepgen TL, Luger TA, et al. High-dose UVA1 therapy for atopic dermatitis: results of a multicenter trial. J Am Acad Dermatol. Apr 1998;38(4):589-93. [Medline].
  29. Leung DY, Nicklas RA, Li JT, et al. Disease management of atopic dermatitis: an updated practice parameter. Joint Task Force on Practice Parameters. Ann Allergy Asthma Immunol. Sep 2004;93(3 Suppl 2):S1-21. [Medline].
  30. Rasmussen JE. Advances in nondietary management of children with atopic dermatitis. Pediatr Dermatol. Sep 1989;6(3):210-5. [Medline].
  31. Reynolds NJ, Franklin V, Gray JC, et al. Narrow-band ultraviolet B and broad-band ultraviolet A phototherapy in adult atopic eczema: a randomised controlled trial. Lancet. Jun 23 2001;357(9273):2012-6. [Medline].
  32. Rosenfeldt V, Benfeldt E, Nielsen SD, et al. Effect of probiotic Lactobacillus strains in children with atopic dermatitis. J Allergy Clin Immunol. Feb 2003;111(2):389-95. [Medline].
  33. Rudikoff D, Lebwohl M. Atopic dermatitis. Lancet. Jun 6 1998;351(9117):1715-21. [Medline].
  34. Ruzicka T, Bieber T, Schopf E, et al. A short-term trial of tacrolimus ointment for atopic dermatitis. European Tacrolimus Multicenter Atopic Dermatitis Study Group. N Engl J Med. Sep 18 1997;337(12):816-21. [Medline].
  35. Sherertz EF. Atopic Dermatitis: Pathogenesis and Treatment. Medscape from WebMD. Available at http://www.medscape.com/viewarticle/427351. Accessed November 14, 2008.
  36. Uehara M, Sugiura H, Sakurai K. A trial of oolong tea in the management of recalcitrant atopic dermatitis. Arch Dermatol. Jan 2001;137(1):42-3. [Medline].
  37. Wahn U, Bos JD, Goodfield M, et al. Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children. Pediatrics. Jul 2002;110(1 Pt 1):e2. [Medline].

 

Supported  by
CLINIC FOR CHILDREN

Yudhasmara Foundation

Office ; JL Taman Bendungan Asahan 5 Jakarta Indonesia 10210

phone : 62(021) 70081995 – 5703646

email : judarwanto@gmail.com,

http://childrenclinic.wordpress.com/

 

 

 

Editor in Chief :

Dr WIDODO JUDARWANTO

email : judarwanto@gmail.com

 

 

Copyright © 2009, Clinic For Children Information Education Network. All rights reserved.

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