Common rashes in early infancy

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					Common rashes in early infancy
                                                                 Doug Trotter, M.D.
                                                                 25 September 2001


Macular and squamous dermatoses

   1. Peeling skin
      Desquamation begins at 24-36 hours and lasts several days, up to 3 weeks.
      Parents report “very dry skin.”
      Underlying skin is normal; no cracking or fissuring.
      No treatment needed. Baby oil is unnecessary.

   2. Diaper dermatitis
      Irritant dermatitis, due to urine and/or feces, aggravated by soap, diapers, etc.
      Tends to involve convex surfaces, sparing intertriginous areas.
      Occasional superinfection with Staphylococcus.
      Treatment: frequent diaper changes, gentle cleansing, and barrier creams.

   3. Candida diaper dermatitis
      Bright, “beefy” red eruption with sharp borders and satellite lesions, often
         involving skin creases.
      Often associated with thrush or candidiasis in other areas, such as neck folds.
      Responds well to topical antifungals.

   4. Cradle cap/seborrhea
      Thick, adherent, yellow scales on the scalp.
      With seborrheic dermatitis, similar scaly areas with red bases appear on trunk and
         extremities, esp. in intertriginous areas.
      Cause is unknown; the yeast Pityrosporum has been seen in infants with cradle
         cap.
      Mild antiseborrheic shampoos and gentle scrubbing are helpful.
      Low potency corticosteroids occasionally needed; ? role for antifungals.


Papular rashes

   1. Sebaceous gland hyperplasia
      Common on nose and cheeks of term infants.
      1-2mm yellow papules, probably due to maternal androgenic stimulation.
      Resolves by 6 months.

   2. Miliaria
      Common in newborns, often in response to thermal stress.
      1-2mm vesicles erupt in intertriginous areas, scalp, face, and trunk, due to
         obstruction and rupture of eccrine sweat duct.
      Treatment: cool, loose-fitting clothing.

   3. Milia
      1-3mm pearly yellow papules on face, chin, and forehead of 50% of newborns.
      Histology: tiny epidermal inclusion cysts, arising from pilosebaceous apparatus.
      Usually resolve without treatment by 1 month, but may persist several months.

   4. Neonatal acne
      Seen in 20% of newborns, any time during first 3 months.
      Mostly closed comedones (whiteheads), with some open comedones (blackheads),
         and occasionally, pustules or cysts.
      Probably due to maternal androgenic stimulation; no apparent association with
         adolescent acne.
      No treatment required.

Pustular dermatoses

   1. Erythema toxicum
      Most common pustular rash, occuring in up to 70% of full term infants.
      Lesions occur from 2 days to 3 weeks.
      2mm red blotchy macules, evolving to pustule on broad erythematous base.
      Lesions scattered on face, trunk, and extremities, fade in 5-7 days.
      Wright’s stain shows eosinophils; 20% show peripheral eosinophilia.

   2. Transient neonatal pustular melanosis
      Occurs on 4% of newborns, esp. black males. Often present at birth.
      2-5mm pustules on chin, neck, trunk, thighs.
      Over several days, lesions crust and desquamate, leaving a hyperpigmented
          macule with a scaly collarette.
      At times, macular stage is the only manifestation at birth.

   3. Acropustulosis of infancy
      Chronic, recurrent, pruritic eruption on palms and soles, but sometimes on scalp,
         trunk, buttock, and extremities.
      Episodes last 1-3 weeks, and recur frequently through infancy, becoming less
         frequent and resolving entirely by age 2-3 years.
      Treatment is Dapsone and/or topical corticosteroids.

Miscellaneous

   1. Acrocyanosis
      Normal, benign, transient vascular phenomena.
      Cyanosis of hands and feet due to cool ambient temperature.
      Distinguish from central cyanosis involving lips, face, or trunk.
2. Cutis marmorata
   Reticulated marbling of skin, also in response to cool temperatures.
   If persistent, may be a marker for trisomy 18, 21, or hypothyroidism.

3. Umbilical granuloma
   Treat with silver nitrate

				
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