Newborn Nasties . . .

Erythema Toxicum Bad name…not toxic Usually occurs in first days of life, last about a week 50% of healthy babies Erythematous macules +/- pustules and papules; pustules stain + for eosinophils Etiology unknown No treatment necessary

Retention of keratin and sebaceous material Can occur at any age; Usually disappears by 3-4 weeks No treatment

Subcutaneous Fat Necrosis Secondary to pressure in utero or during labour Occurs during first days or weeks Circumscribed erythematous or violaceous plaques Infrequently associated with hypercalcemia

Sucking blister

Cutis marmorata/livedo reticularis This is often a referral from health professionals SHOULD BE INTERMITTENT WHEN EXPOSED TO LOW TEMPERATURES!! IF PERSISTENT/SEVERE, SEEK HELP! Persistent and pronounced cutis marmorata occurs in Menkes disease, familial dysautonomia, and Cornelia de Lange, Down, and trisomy 18 syndromes

Transient Neonatal Pustular Melanosis Pustular melanosis, which is more common among black than among white infants, is a transient, benign, self-limited dermatosis of unknown cause that is characterized by 3 types of lesions: (1) evanescent superficial pustules; (2) ruptured pustules with a collarette of fine scale, at times with a central hyperpigmented macule; and (3) hyperpigmented macules. Lesions are present at birth, and 1 or all types of lesions may be found in a profuse or sparse distribution. Pustules represent the early phase of the disorder, and macules, the late phase. The pustular phase rarely lasts more than 2–3 days; hyperpigmented macules may persist for as long as 3 mo. Sites of predilection are the anterior neck, forehead, and lower back, although the scalp, trunk, limbs, palms, and soles may be affected

Infantile Acropustulosis In contrast to pustular melanosis, kid is older and symptomatic Pustules (vesicles) on the hands, feet and dorsal surfaces Intensely pruritic and recurrent; each episode lasts 7-14 days, and recurs every 2-4 weeks Occurs between 2-10 mos and resolves 24-36 mos Treated with anithistamines and fluorinated corticosteroids if severe

-neonatal HSV – 3mm vesicles with crusted erosions appearing at 3 days of age over the scalp – grew HSV

Seborrheic Dermatitis Malassezia furfur has been implicated as a causative agent, although its role in the etiology of infantile seborrheic dermatitis is unclear. Treatment. Scalp lesions should be controlled with an antiseborrheic shampoo (selenium sulfide, sulfur, salicylic acid, zinc pyrithione, tar), used daily if necessary. Inflamed lesions usually respond promptly to topical corticosteroid therapy. Topical immunomodulatory agents (tacrolimus, pimecrolimus) approved for the treatment of atopic dermatitis in children ≥2 yr of age may have a role in the treatment of other eczematous disorders such as seborrheic dermatitis. Concerns for systemic absorption and potential immunosuppression are higher in the younger patient population typically afflicted with seborrheic dermatitis. Topical antifungal agents effective against Malassezia have been advocated. Wet compresses should be applied to the moist or fissured lesions before application of the steroid ointment. Many patients require continued use of an antiseborrheic shampoo. Response to therapy is usually rapid unless there are complicating factors or the diagnosis is in error

Diaper Dermatitis – good barrier cream, air-dry/O2, topical corticosteroids Treatment includes measure to decreased maceration of skin (ie changing diaper frequently, leaving diapers off for long periods) plus antifungal therapy. -ointments, creams and powders of nystatin, miconazole and clotrimazole available. -unclear whether oral antifungal therapy should be used in addition to topical, some studies show no difference others show relapse rate lower if use both. -there are no well designed trials looking at role of steroids in CDD. Hypothesis that anti-inflammatory with antifungal will have better response, but perhaps steroids would impair the response to antifungal. POTENT STEROIDS should be avoided.