RxPG - neonatal skin rashes

Neonatal and Infantile Common Skin Lesions

Case

A three week old baby come to the office with the chief complaint of an extensive rash. The child seems comfortable and is nursing well. There is no history of atopy in the family. The rash is confined primarily to the scalp, neck, and axillary areas. There are waxy scaly lesions with minimal weeping. What's your diagnosis?

Newborn skin is thinner and has less hair than older infants. There is a paucity of normal protective skin flora and there are potentially vulnerable areas around the cord, scalp lesions, and circumcision for invasion of organisms. . Babies all receive some type of cord care immediately after delivery.

Normal variations
1.Acrocyanosis-purplish discoloration of the hands, feet, and around lips in response to crying, holding breath and cold.
2Cutis Marmonata- bluish mottling of the skin on tunk and extremities. Common when infant is cold.
3Harlequin Color Change- half the body red and the other pale. Benign
4Subcutaneous Fat Necrosis- firm circumscribed nodules over bony prominence secondary to pressure. Will involute spontaneously in few months in most cases. Often associated with forcep use at delivery.
5Miliaria- "prickly heat" Papular vesicular lesions secondary to sweat retention. Self limited and treat by keeping baby cool.
6Milia- whitish yellow papules lesions greatest on the nose, chin, cheeks, and forehead. Secondary to retention of sebum. Usually disappear in a few weeks.
7Neonatal Acne- papular rash that usually appears around 2-4 weeks. Probably caused by sebaceous gland reaction to hormones. May be extensive but rarely needs therapy with comedolytic agents,
8Erythema toxicum- red macules that evolve into papules and pustules. Eosinophiles if scrapped. No therapy necessary
9Transient Neonatal Pustular Melanosis- Vesiculopustular lesions that rupture leaving pigmented macules that eventually fade. If you stain contents, mainly neutrophiles will be seen
10Seborrheic Dermatitis- Waxy scaly lesions greatest on the scalp(cradle cap), intertriginous areas, behind the ears, trunk, and face. Usually not pruritic and no atopy history. May have some crustiness and oozing. Early onset and lack of pruritis help differentiate seborrhea from atopic dermatitis. Treat scalp with dandruff shampoo or 1% salicylic acid in petroleum jelly and other lesions usually self-limited but may respond to mild cortisone creams or ointments.
11Diaper rash- wetness is the prime cause of diaper rash. Wetness leads to increased permeability of the skin to irritants and change of pH. This allows increased activity of stool lipase and protease.
Treatment
frequent changing
wash thoroughly
gentle drying
avoid perfumes and harsh soaps
no rubber pants
use barrier cream
corticosteroids if inflammation
Anti-fungals if candida
topical antibiotics if looks like secondary bacterial infection
Avoid Mycolog and Lotrisone because contain potent steroid