Paediatrics: Neonatal dermatology

Neonatal dermatology

Neonatal skin is covered with vernix at birth and is poorly keratinized. There is reduced resistance to bacterial infection, increased water loss, increased absorption of drugs (all more pronounced with prematurity.)

The following conditions are all benign and resolve without treatment, often within a few weeks of birth.

•   Milia: <2mm yellowish-white spots, usually on the face, secondary to blocked sebaceous/sweat glands.

•   Erythema toxicum (erythema neonatorum): erythematous macular– papular discrete lesions, often with a white centre, mostly present over the knees, elbows, trunk, and face. Very common particularly in post-mature infants.

•   Harlequin colour change: marked erythema or pallor in different halves, or quadrants, of body. s to vasomotor immaturity.

•   Cutis marmorata (livedo reticularis): marble-like colour change in well baby, secondary to vasomotor immaturity.

•   Sucking blisters: common on hand, wrist, or upper lip.

•   Superficial capillary haemangioma (salmon-patches, stork marks): erythematous vascular marks common on eyelids, face midline, and posterior scalp, particularly over the nape of neck (tends to persist at latter site).

•   Mongolian blue spots: bluish-black macules, most often in lumbar–sacral region, common in non-Caucasians. May last several years.

Nappy rash

Usually a contact dermatitis from ammonia released by bacterial break-down of urine.

Treatment

Includes:

•   Frequent nappy changes.

•   Barrier cream, e.g. zinc and castor oil cream; expose to air.

•   Suspect secondary Candida infection if worse in flexures or satellite lesions present. Treat with topical antifungal, e.g. nystatin ointment 6-hourly (if severe may benefit from oral antifungal simultaneously).

Infantile seborrhoeic eczema

Very common. Usually appears after a few weeks. Erythema and scaling rash affects face, neck, behind ears, axillae, scalp (cradle cap), upper trunk, napkin area, and flexures. Majority spontaneously resolve within weeks. Minority will go on to develop atopic eczema, particularly if there is a family history.

Treatment

•   Avoid detergents (i.e. soap).

•   Use topical emollients.

•   Mild topical steroid/antifungal preparation (e.g. 1% hydrocortisone cream).