skin disorders in newborn

skin @ birth covered with vernix caseosa
1. = chalky-white greasy coat, made of water, proteins & lipids
  1. protects skin in utero from amniotic fluid
2. vernix shedding coincides w/ transepidermal layer maturation
preterm infant's skin
1. thin
2. poorly keratinised
3. no subcutaneous fat
4. sig more transepidermal water loss than term baby
5. unable to sweat till a few weeks old
  1. (term infants can sweat from birth)
bullous impetigo
1. uncommon
2. potentially serious blistering form of impetigo
3. seen esp in newborn
4. most often caused by Staph aureus
5. Rx w/ systemic Abx
  1. e.g. penicillinase-resistant penicillin
melanocytic naevi (moles)
1. congenital moles in up to 3% of neonates
  1. usually small
2. congenital pigmented naevi > 9cm diameter (i.e. extensive)
  1. rare but disfiguring
  2. carry 4-6% risk of subseq malignant melanoma
  3. need quick referral to derm & plastic surgeon
    1. assess feasibility of removal
3. melanocytic naevi increasingly common w/ age
  1. presence in adult may be indicative of childhood sun exposure
4. avoid prolonged sun exposure
  1. use >20 SPF sunscreen to exposed skin in bright weather
    1. reapply every few hours
5. malignant melanoma
  1. rare before puberty
    1. incidence risen sig in adults
  2. risk factors
    1. +ve fam hx
    2. large no of melanocytic naevi
    3. fair skin
    4. repeated episodes of sunburn
    5. living in a hot climate w/ chronic sun exposure
albinism
1. due to defect in biosynthesis & distribution of melanin
2. distribution of depigmentation in skin & eye
  1. oculocutaneous
  2. ocular
  3. partial
3. causes visual impairment
  1. failure to develop fixation reflex
    1. due to lack of pigment in iris, retina, eyelids & eyebrows
  2. pendular nystagmus & photophobia
    1. -> constant frowning
  3. refractive errors
    1. correct w/ tinted contact lenses
      1. in some kids, fitting these from early infancy allows development of normal fixation
4. pale skin prone to sunburn & skin Ca
5. when in sunlight
  1. wear a hat
  2. apply high factor sunscreen
epidermolysis bullosa
1. rare group of genetic conditions w/ blistering of skin & mucous mb
  1. autosomal dominant types milder
  2. autosomal recessive types may be severe & fatal
    1. scarring follows recurrent blistering
2. blisters occur spontaneously or follow minor trauma
  1. need to differentiate these from scalds
3. Mx
  1. maintain adequate nutrition
  2. MDT
    1. paed dermatologist
    2. paediatrician
    3. plastic surgeon
    4. dietician
  3. avoid inj from even minor skin trauma
  4. treat 2ary infection
4. severe forms
  1. fusion of fingers & toes
  2. contractures of limbs develop
    1. cos of repeated blistering & healing
5. mucuous mb involvement
  1. oral ulceration
  2. stenosis
    1. -> oesophageal erosions
collodion baby
1. rare manifestation of inherited icthyoses
  1. group of dry & scaly skin conditions
2. infant born w/ taut parchment-like or collodion-like mb
  1. mb gets fissured & separates within few weeks
    1. can leave ichthyotic or normal skin (less common)
3. Mx
  1. emollients
    1. to moisturise & soften skin

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skin disorders in newborn

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