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the following findings on a neonatal dermatologic exam are considered to be ...: Vernix Lanugo Mottling

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normal

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... is a scary finding on a neonatal dermatologic exam because they can be an indicator of sepsis

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petechiae

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.... is a protective barrier that protects baby from fluid filled environment in utero (looks like a white covering), and rubbing the .... into body is ok, won't prevent baby from having dry skin and the baby will still lose top layer of skin, before they get beautiful baby skin

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vernix

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... can be considered a normal sign on a newborn dermatologic exam when they are non-blanching lesions secondary to birth trauma or vigorous resuscitation

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petechiae

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when considered a normal sign on a newborn dermatologic exam, are usually found on the forehead, ribs, and inguinal canals (Forehead and ribs is normal- squeezing during birth- trauma) ( and Inguinal canal- is from overzealous providers trying to find femoral pulses)

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petechiae

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... is downy hair present to varying degrees at birth. Some infants have a lot, some have a little, all eventually falls or gets rubbed off, and is generally in a nice fuzzy pattery that goes over shoulders. Latino babies have the most

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lanugo

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aka cutis marmorata, is a lace-like pattern of dusky erythema over trunk and extremities seen on newborn dermatologic exam

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mottling

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aka mottling, is a lace-like pattern of

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cutis marmorata

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... is a normal finding in newborns who are cold - disappears on re-warming. (lace-like pattern of dusky erythema over trunk and extremities)

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mottling

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Can be a sign of poor perfusion in illness - look for other physical exam finding

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mottling

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... is a rare congenital vascular malformation, that in the newborn dermatologic exam usually presents on one limb, and is associated with underlying muscular defects (50%). This condition usually resolve with time - but should be followed for the risk of ulceration.

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Cutis marmorata telangiectatica congenita

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forceps markings and scalp abrasions from opperative births and internal monitoring respectively are ... lesions on newborn derm exam

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transient

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... is a transient finding on newborn derm exam in which there are white to yellow papule on a blotchy erythematous base, found everywhere except on the palms and soles, that starts on DOL 1 or 2 and can come and go over first 10 days of life.

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erythema toxicum

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.... contains eosinophils, seen in hives or allergic reaction, and is a reaction to birth/being in environment that changes rapidly. Its etiology is poorly understood. And finally it is worse in areas of high friction and heat.

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erythema toxicum

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are transient keratin-filled epithelial cysts. Which are often mistaken for neonatal acne which does not appear until 2 weeks of life. That lacks an inflammatory component

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milia

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... are transient lesions that are more yellow than milia, and are caused by maternal androgen exposure, and these lesions spontaneously resolve

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Sebaceous Gland Hyperplasia

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... is a Fragile pustular rash that begins in-utero, which is often broken down during delivery, resuscitation, drying, and first bath

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transient pustular melanosis

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... is a transient finding that when pustules break they leave behind a white collarette with a central hyper-pigmented macule, and has no inflammatory component. Is more common in African American babies (4%) than in the general population (2%).

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Transient pustular melanosis

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... is a transient lesion usually seen on the newborn's penis and scrotum

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Transient pustular melanosis

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dry skin, meconium staining and sucking blisters (from sucking in utero) are normal .... lesions on newborn derm exam that may bother parents

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transient

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.... represent an area of excess of one or more of the normal components of skin per unit areas.

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birthmarks

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... is a birthmark in which there is an excess of blood vessels

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Hemangioma

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... or birthmark, is a birthmark in which there is excess skin pigment in the epithelial cells

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mongolian spot

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.... are blue-black macules commonly located over lumbosacral area.

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Mongolian Spots

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... are Most common in Black, Asian and Hispanic infants. These marks fade with time, but it is important to clearly record location of macules as they are easily confused for bruising.

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mongolian spots

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... can be differentiated from bruises because they all are the same color, and all of them remain the same color the next day as well

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mongolian spots

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... are light brown oval macules that can be irregularly shaped, and normally single lesions occur, so Measure size and draw location

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Cafe Au Lait Spots

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... is often diagnosed because of unusual pigmentary patterns. Café au lait spots are irregularly shaped, evenly pigmented, brown macules. Most individuals with .... have 6 or more spots that are 1.5 cm or greater in diameter

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neurofibromatosis

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In young children, ...or more café au lait macules greater than 0.5 cm in diameter are suggestive of neurofibromatosis and further diagnostic workup should be pursued.

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5

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Multiple .... lesions associated with neurofribromatosis.

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Cafe Au Lait Spots

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with ... 40% present at birth, and are common on face in the newborn but can be found anywhere, and are well delineated made up predominantly of an excess of arteries

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hemangiomas

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have an excess of arteries making up a well delinated lesion that has rapid neonatal growth with slow involution

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hemangiomas

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99% of .. are present at birth, are common on limbs but can be found anywhere, and is poorly circumscribed

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vascular malformation

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... is a lesion made up mostly of venous vessels and there are no change in size, grows with child, no involution

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vascular malformation

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... are Benign neoplasm resulting from rapid proliferation of endothelial cells, mostly arterial vessels, but are fairly subtle at birth

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hemangiomas

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... are Superficial (strawberry), deep or mixed lesions of predominantly arterial vessels that proliferate for 8-18 months then regress (10% per year). So 50% gone by age 5, 90% gone by age 9 (10% per year).

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hemangiomas

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indications for treatment involving the removal of a ... include: 1. Obstructed vision. 2. High-output heart failure. 3. ones in the diaper area because tend to ulcerate. 4. Facial lesions because they can disfigure even after they regress

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hemangiomas

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the following are classified as... : Salmon Patches Port Wine Stains Cutis Marmorata-CMTC

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vascular malformations

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Light red blanching macule on nape of neck (stork bite) or glabella/eyelids (angel kiss).

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salmon patches

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is a salmon patch on the neck

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stork bite

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an ... is a salmon patch on the glabella/eyelids

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angel kiss

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... occur in 70% white babies, 60% black babies. and will fade with time but always present - more pronounced when flushed, even later as an adult

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salmon patches

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aka Nevus Flameus are Flat dark pink to red macule found on face or limbs. Do not cross midline

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port wine stain

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aka port wine stain is made up of Flat dark pink to red macule found on face or limbs that do not cross midline

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nevus flameus

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is a port wine stain On face and involving an eye, and is a hemangioma of face and meninges and is associated with seizures

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Sturge-Weber syndrome

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is a port wine stain on the legs that is Associated with hemihypertrophy

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Klippel-Trenauna syndrome

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Severity of ... differentiates port wine stain from salmon patches these two as well as distribution

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color

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... . It is characterized by a triad of port wine stain, varicose veins and bony and soft tissue hypertrophy involving an extremity {1}. Most cases are sporadic {2}, although few cases in the literature report an autosomal dominant pattern of inheritance {3}. The exact cause of this syndrome remains to be elucidated, underlying mixed mesodermal and ectodermal dysplasia is likely responsible {4}. It generally affects the single extremity although cases of multiple affected limbs have been reported. Diagnosis is mainly clinical {1}. Treatment is conservative and symptomatic.

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Klippel Trenaunay Syndrome

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.... must be considered if vesiculobullous or pustular lesions are found in a newborn.

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infection

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herpes simplex, varicalla zoster, CMV and coxsackie, are all .. infections that can cause vesiculobullous or pustular lesions in the newborn

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viral

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... lesions generally do not appear at birth but rather days to weeks later.

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infectious

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Staphylococcus, Bullous Impetigo, are ...infections that can cause vesiculobullous or pustular lesions in the newborn

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bacterial

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... and its lesions are acquired from mother with genital infection, and the first maternal infection is the most likely to infect baby; therefore, often undetected.

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herpes simplex

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Intact membranes will usually protect baby from acquiring .. that can lead to erythemetous papules lesions

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herpes simplex

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... is a way to attempt prevention of vertical transmission of herpes simplex from other to infant, but can still be acquired anyway

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Cesarian section

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is a scary viral infection for pregnant mothers to have because it causes high morbidity and mortality in newborns

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herpes simplex

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in pregnant mothers with herpes simplex they are placed on valtrax during pregnancy, and any active lesion is treated

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herpes simplex

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infection with ... via vertical transmission causes 1 to 3 mm vesicles and erythematous papules that may develop into pustules, crust and erosions (usually in clusters). Usually occur on the scalp or face. (trunk or buttocks if breech) (really depends on what part of the body is presented to the vagina

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herpes simplex

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is an infection in the newborn that typically, seen after few days of life (days 3 to 7). Generally is 1 lesion, and May affect any part of the body.

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staphylococcus

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... infection is Caused by Staphylococcus aureus. If one lesion is seen, it may be treated "expectantly" with application of chlorhexidine mainly to prevent spread. Filled with white fluctuant material However, if more than one lesion exists, then a course of oral antibiotic is indicated after a culture is taken.

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staphylococcus

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.. lesions are described as pustules and papules with honey colored crusts

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staphylococcus

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... is Typically caused by Staphylococcus aureus and its lesions tend to appear in the later part of the first week of life or into the second week. (Any body site may be involved esp. diaper area)

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bullous impetigo

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in ... the bullae are flaccid, containing straw colored or turbid fluid, rupture easily leaving a moist denuded area. These lesions Heal without scarring. and Treatment with a systemic antibiotic clears up infection

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bullous impetigo

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... are lesions that are slightly raised oval or linear area, yellow or orange, and are common on scalp, associated with alopecia.

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Sebaceous Gland Nevi

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... consist of hypertrophy of sebaceous glands (glands which produce acne later), and do have malignant potential later in life - consider removal (basal cell carcinoma).

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Sebaceous Gland Nevi

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... are hamartomas arising from the embryonic ectoderm that may be deeply or slightly pigmented.

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Epidermal Nevi

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in ... they have either a unilateral or bilateral distribution, and often favor the extremities in what appears to be a dermatomal distribution. Onset is usually at birth but may also occur in the second or third decade.

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epidermal nevi

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important qualities to remember about the .. of newborn: Thinner Large surface area-to-body ratio

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skin

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as a result of the newborn's skin being thinner and having a large surface area to body ratio, is decreased .... function relative to adults/older children: Particularly true for premature neonates *So Avoid chemical agents, esp. topical steroids*

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barrier

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... are recommened for bathing infants until the cord falls off

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sponge baths

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after the cord falls off Then bathe in water without ... or bubbles no more than a couple times a week. Use ... only if baby very dirty or smelly. Water temp <120 F.

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soap

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Regular neck/skin fold cleanings with a burp cloth enough to keep an infant ....

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clean

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Don't start using soap and water until age ..., until they are getting into dirt. Infants and small children should bathe less than 2 to 3 times a week

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2

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is the key for diaper rash

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prevention

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to prevent ... change diapers with every feed, Use mild wipes - without additives. (water and washcloth best!), and allow area to fully dry before putting on new diaper.

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diaper rash

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also to prevent ... Apply a thick layer of protective ointment or cream (such as one that contains zinc oxide or petroleum jelly). These ointments are usually thick and pasty and do not have to be completely removed at the next diaper change. Remember, heavy scrubbing or rubbing will only damage the skin more

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diaper rash

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candidal diaper rash is caused by ... and has satellite lesions, is most prominent in skin folds. and treatment is topical antifungal cream, eg, mycostatin

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candida albicans

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... diaper rash is Caused by chemical irritant. 20% of babies will develop by 2 yrs. Most pronounced on convex areas, spares skin folds. Treatment: remove irritant, air dry, use petroleum barrier.

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