1. Transient Skin Diseases1

2. Disease #1 2

4. Milia
Found on the skin in 40% of infants and on the palate in 60% of infants
Known as Epstein’s Pearls when found in the oral cavity
Multiple, white, 1 to 2-mm papules seen on the forehead, cheeks and nose
Inclusion cysts which contain trapped keratinized stratum corneum
Rupture and exfoliate their contents within a few weeks of birth- no treatment required

5. Sebaceous Gland Hyperplasia
1mm yellow macules or yellow papules
Seen at the opening of each pilosebaceous follicle over the nose and cheeks
Occur in ~50% of infants
Recede by 4 to 6 months of age
Pathogenesis: maternal adrogenic stimulation causes increased sebaceous gland volume, cell size, and total number os sebaceous cells

6. Miliaria
Cutaneous changes associated with sweat retention and extravasation of sweet occuring at different levels of the skin
Usually due to overheating
Miliaria rubra (prickly heat)
blocked sweat into the epidermis producing red papulovesicles
Miliaria crystallina
blocked sweat escapes just beneth the skin surface producing noninflammatory vesicles which look like “clear droplets” 6

7. Milia Crystallina 7

8. Disease #2 8

10. Mottling Lacelike pattern of dusky erythema
Appears on the extremities and trunk after exposure to a temperature decrease and disappears on rewarming
Pathogenesis: immaturity of the autonomic control of the skin vascular plexus
Constriction of the deeper plexus and opening of the superficial plexus
Mottling that persists after 6 months may be a sign of hypothyroidism or the vascular malformation cutis marmorata telangiectatia congenita (associated with musculoskeletal or vascular abnormalities)

11. Disease #3 11

12. 12

13. Harlequin Color Change
Develops when a low-birth-weight infant is placed on one side
An erythematous flush with a sharp demarcation at the midline on the dependent side
Upper half of the body becomes pale
Color change may persist up to 20 minutes after placing the infant supine
Pathogenesis: Thought to be due to immaturity of the autonomic vasomotor control 13

14. Disease #4 14

15. 15

16. Subcutaneous Fat Necrosis
Firm, sharply circumscribed, reddish or purple nodules on cheeks, buttocks, arms, and thighs
Usually appear within the 1st weeks of life
Spontaneously resolve over several weeks to months
Atrophy can occur during healing leading to a depression/ dimpled area
Hypercalcemia may occur with or without weight loss, irritability, vomiting, and failure to thrive
Differential Diagnosis: Cellulitis or septicemia
Pathogenesis: Cold injury 16

17. Disease #5 17

18. 18

19. Sucking Blisters
Solitary, intact oval blisters or erosions on noninflamed skin
Occur on forearms, wrists, fingers, or upper lip
Usually resolve within a few days
Differenital Diagnosis: Herpesvirus, Bullous impetigo
Pathogenesis: Vigorous sucking in utero 19

20. Disease #6 20

21. 21

22. Erythema Toxicum
Blotchy, erythematous macules 2 to 3 cm in diameter with a tiny 1- to 4- mm central vesicle or pustule
Seen on chest, back, face, and proximal extremities
Spares the palms and soles
Usually begin 24 to 48 hours of age
Clear in 4 to 5 days
New lesions may appear up to day 10 of life
Occur ~50% of term infants
Smear of lesions reveal numerous eosinophils 22

23. Disease #7 23

24. 24

25. Transient Neonatal Pustular Melanosis
Vesicles, pustules, or ruptured vesicles or pustules with a collarette of surrounding scale present at birth
Pigmented macules develop at site of resolving lesions
Pustules usually disappear by 5 days of age
Macules resolve over 3 weeks to 3 months
Smear of lesions reveal numerous neutrophils and occasional eosinophil
Lesions more common on African American infants
Diff Dx: Herpes simplex or bacterial folliculitis
Pathogenesis: Unknown c 25

26. Macules of Resolving Transient Neonatal Pustular Melanosis26

27. Pustules in the Newborn27

28. Disease #8 28

29. 29

30. Acne Neonatorum Clinical Findings
Appears as multiple, discrete papules at weeks of life
Usually seen on face, chest, back, and groin
Papules evolve in pustules after a few weeks
Comedones lacking
May persist up to 8 months of age
Differenital Dx: Erythema toxicum, transient neonatal pustular melanosis, Herpes Simplex, Candidiasis
Pathogenesis: Controversial
May be a hyposensitivity reaction to Malassezia furfur
Treatment: Usually resolves spontaneously 30

31. Infantile Acne Clinical Findings:
Develops ~2-3 months of life
Papules, pustules, and open and closed comedones
More commonly seen in boys
Usually resolved over months
Pathogenesis: Androgenic stimulation of the sebaceous glands
Treatment: Usually self resolves
Persistant cases may require treatment with topical benzoyl peroxide or antibiotics 31

32. Disease #9 32

33. 33

34. Congenital and Neonatal Candidiasis
Candida albicans can be acquired prior to birth or during the birth process
Infants with congenital disease present at birth with scaling lesions, erythematous papules, and pustules
Infants with neonatal disease develop lesions several days or weeks after birth
May have diffuse scaling dermatitis or present with typical satellite lesions in intertriginous area
Diagnosis made my skin scrapping/ KOH prep
Demonstrate pseudohyphae and/or budding yeast
Skin culture will demonstate C. albicans 34

35. Congenital and Neonatal Candisiasis
Differenital Dx: Erythema toxicum, miliaria, transient neonatal pustular melanosis, herpes simplex
Low birth weight infants can develop systemic candidiasis
Pathogenesis: C. albicans can penetrate through the amnion and chorion to cause congenital infection
Neonatal infection acquired during the birth process through the vagina colonized with candida
Treatment: Topical Antifungal for cutaneous lesions and IV antifugals for systemic disease 35

36. Disease #10 36

37. 37

38. Acropustulosis of Infancy
Presents as pustules or vesicles on the palms and soles
May appear at birth or occur up to age 3
Recurrent crops of erythematous papules that becomes pruritic pustules and resolve with a scale
Differenital Dx: Scabies
Pathogenesis: Unknown 38

39. Disease #11 39

40. 40

41. Herpes Simplex Infection
Clinical Features
Grouped vesicles on an erythematous base
Mean age of onset of lesions 6 days
May be present at birth
Differential DX: varicella, bullous impetigo
Pathogenesis: Herpes Simplex Virus
60-80% Type 2
Infants born to mothers with a primary infection at highest risk
Work-Up: Viral culture of skin lesions, urine, nasopharynx, eyes, and CSF
Treatment: IV Acyclovir 41

42. Disease #12 42

43. 43

44. Varicella Clinical Features: May mimic herpes simplex.
Lesions appear in crops of macules and papules that evolve into vesicles and then crust
Age of onset in the first 10 days of life
Differential DX: herpes simplex, bullous impetigo
Pathogenesis: Maternal infection with VZV
Treatment:
Varicella Immune Globulin if maternal infection is presents from 5 days prior to delivery to 2 days post- partum.
nfected infants are treated ith acycolvir.
May consider VZIG for premature and term infants exposed postnatally 44

45. Disease #13 45

46. 46

47. Omphalitis Clinical Features: Differential DX: Pathogenesis:
Redness and induration of the umbilical region
Differential DX:
Irritant dermatitis secondary to treatment of the umbilicus with bacteriostatic agents
Pathogenesis:
Bacterial infection through the cut surface of the umbilical cord
Predominantly caused by S. aureus
If untreated, may lead to sepsis
Treatment: IV antistaphylococcal antibiotics 47

48. Disease #14 48

49. 49

50. Aplasia Cutis Congenita
Clinical Features:
Congenital absence of skin
Oval, sharply marginated, 1 -2 cm depressed areas
Usually occurs in a small, localized area primarily on the posterior scalp
Differential DX: Scalp ulcer
Pathogenesis:
Developmental failure of skin fusion. Dermis, epidermis, and fat may be missing
~25% have skull abnormalities. Consider trisomy 13, if multiple lesions.
Treatment: Small lesions corrected with surgical excision. Large lesions may require hair transplantation 50

51. Vascular Abnormalities51

52. Disease #15 52

53. 53

54. Hemangiomas Clinical Features: Occur in ~2.5% of neonates
May resemble a port-wine stain, bruise, or hypopigmented macule
Lesions may only be evident by a circumscribed area of blanched skin with a few telangiectases
Areas being to becomes raised by 2-4 weeks of age
Lesions grows out of proportion to the infant for the 1st 8-12 months of life
Usually begin to involute ~15 months
Signified by pale gray areas within the nodule
Female to Male ratio 3:1
50% will disappear by 5 years and 90% by 9 years 54

55. Hemangioma Complications
Ulceration due to secondary S. aureus superinfection
Depends on locations
Problematic Locations
Periorbital lesions: Astigmatism, amblyopia, refractive error or blindness
Beard lesions (Mandible, chin, submental): Subglottic hemangioma- leading to stridor, cough, respiratory difficulty
Ear: Risk of obstruction leading to conductive hearing loss
Nose/Lips: Greater tendency to ulcerate/ cosmetic deformity
Midline lumbosacral region: Increased risk of spinal dysraphism
Need an MRI to r/o spinal abnormalitites
Multiple cutaneous (>5) hemangiomas: Associated with visceral lesions, especially of the liver 55

56. PHACE SYNDROME P: Posterior fossa abnormalitites
(Dandy Walker Syndrome)
H: Hemangiomas
(usually large, cervicofacial lesion involving distibution of cranial nerve VI)
A: Arterial anomalies
(usually intracerebral arterial anomalies)
C: Cardiac Defects
(especially coartation of the aorta)
E: Eye abnormalitites
(micro-opthalmia) 56

57. Hemangiomas Treatment: Usually none
Problematic locations may require systemic cortiocosteroids 57

58. Disease #16 58

59. 59

60. Dermal Melanosis Clinical Features:
Usually present at birth
Flat, deep brown to slate gray, or even blue-black
Most common sites are lumbosacral region, back, flanks, and shoulders
Seen in >90% of African American and Native American infants
Occurs <10% of caucasian infants
Disappear or fade over years
Differential DX: Non-accidental trauma
Pathogenesis:
Treatment: None required 60

61. Disease #17 61

62. 62

63. Supernumerary Nipples
Clinical Features:
Differential DX:
Pathogenesis:
Treatment: 63

64. Disease #18 64

65. 65

66. Cutis Marmorata Telangietatica Congenita
Clinical Features:
Differential DX:
Pathogenesis:
Treatment: 66

67. Disease #19 67

68. 68

69. Epidermal Nevi Clinical Features: Differential DX: Pathogenesis:
Treatment: 69

70. Disease #20 70

71. 71

72. Lymphangioma Clinical Features: Differential DX: Pathogenesis:
Treatment: 72

73. Disease #21 73

74. 74

75. Sebaceous Nevi Clinical Features: Differential DX: Pathogenesis:
Treatment: 75

76. Disease #22 76

77. 77

78. Nevus Comedonicus Clinical Features: Differential DX: Pathogenesis:
Treatment: 78

79. Disease #23 79

80. 80

81. Aplasia Cutis Congenita
Clinical Features:
Differential DX:
Pathogenesis:
Treatment: 81

82. References