Neonatal skin rashes

most these skin rash are afebrile

1. NEONATAL SKIN RASHES SINGI

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%

5. Transient vascular phenomena

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. M iliaria 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. R eference American family physician, V ol 77, No.1, Jan 1,2008 Notes of prof Muganga Australia Family physician ,Vol 41,No.5, May 2012

24. NEONATAL SKIN RASHES SINGI

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%

28. Transient vascular phenomena

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. M iliaria 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. R eference American family physician, V ol 77, No.1, Jan 1,2008 Notes of prof Muganga Australia Family physician ,Vol 41,No.5, May 2012