Neonatal Eruptions

Erythema toxicum onset: within 1st 4 days (peak day 2) delayed onset may occur up to 14 days incidence: 30-70% of full term infants, 5% preterm lesions: pustule on erythematous base swab shows eosinophils location: mostly truncal, also limbs/ face (spare palms & soles) natural history: may coalesce/ intensify esp in response to local heat wax & wane over following 3-6 days resolve within 1-2 wks may recur up to 6 wks (rare) Infantile Acne inflammation 2 to Malaezzia furfur Transient Neonatal Pustular Melanosis pustules brown pigmented (can have both stages at birth) Milia onset: birth or subsequently location: common on face/ scalp, can be anywhere lesion: tiny white papules usually discrete, called Epsteins pearls when on hard palate natural history: resolve within a few months without treatment aetiology: inclusion cysts - trapped keratinised stratum corneum Milaria = sweat trapping superficial clear vesicles (crystillina) deeper red (rubra) even deeper pustulosa avoided by adequate air conditioning Seborrhaeic dermatitis location: scalp (cradle cap) intertriginous areas hairline/ naso-labial/ groin/ axilla onset: most common in 1st 6 weeks, can occur up to 6 months can also recur in adolescence note: neonates/ adolescents = seborrhaeic sebborrhaic dermatitis/ cradle cap children = non-seborrhaiec eczema/ candida lesions: scalp - greasy, yellow plaques not itchy natural history: can lead to secondary Candidal infection likely to be 2 to M.furfur as responds to ketaconazole management: remove scale without irritating skull olive oil, soap substitutes (QV bath oil) hydraderm/ dermeze ketaconazole if recurrent nb. if > 6 months old NOT cradle cap = scalp eczema usually have eczema elsewhere usually itchy scale harsher/ drier Nappy dermatitis onset: 1st few months aetiology: irritant contact dermatitis (irritants = heat/ moisture/ urine & stool) may be super-infected with Candida albicans lesion: perineal erythema (sparing of skin folds)

satellite lesions which may coalesce +/- appearance of scale management: change nappies promptly (use disposable nappies) liberal use of barrier creams cod liver oil/ olive oil & zinc topical nystatin/ miconazole if appears infected 1% hydrocortisone to settle inflammation