NEWBORN RASHES

INCREASED PIGMENTATION

ACROCYANOSIS
Incidence: First 2-4 weeks of life Clinical features: The hands and feet become symmetrically blue in color secondary to cold Significance: Differentiate from central cyanosis Course and prognosis: Resolves on warming. Does not occur after one month of age.

ACCESSORY NIPPLES
Incidence: Present at birth Clinical features: Appears a line from the mid-axilla to the inguinal area Significance: Develops without areola, misdiagnosed as congenital nevi Course and prognosis: Excised for cosmetic purpose

MONGOLION SPOT
Incidence: Universal in non-Caucasian neonates, and Asian infants. Occasionally in Caucasian infants with dark hair Clinical features: bluish pigmentation usually in lumbosacral regions Significance: mistaken for bruising Course and prognosis: becomes less obvious as the infant grows older

DECREASED PIGMENTATION

VITILIGO
Incidence: 1-2% of the population. Autosomal dominant with variable penetration Clinical features: Occurs at any age. Melanocytes are absent Significance: Differentiated from Abinism that occurs at birth. Course and prognosis: Long periods of quiescence may be interrupted with periods of extension during severe stress. Spontaneous repigmentation is unusual

ALBINISM
Incidence: 1-7%. Inherited as Autosomal recessive Clinical features: Generalized hypopigmentation of the skin, eyes, and hair Significance: Skin protection from sun Course and prognosis: The skin becomes wrinkled, and easily blistered by sunshine. Malignant skin tumors are common. Life expectancy may be reduced

TRANSIENT AND BENIGN LESIONS

MILIA
Incidence: Very common. 40-50% of newborn infants. Clinical features: fine white spots seen on the nose and cheeks. Hypertrophic sebaceous glands Significance: mistaken for infection Course and prognosis: disappear spontaneously

TRANSIENT NEONATAL PUSTULAR MELANOSIS

Incidence: 4% of newborns. Particularly black male infants Clinical features: Present at birth. 2 to 5 mm diameter pustules on a non-erythematous base. Wright stain shows eosinophils and neutrophils Significance: none Course and prognosis: lesions develop a central crust, which desquamates to leave a hyperpigmented macule with a collarette of fine scales.

ERYTHEMA TOXICUM
Incidence: Extremely common. Affected in the first week of life. Not seen in preterm infants. Clinical features: Vesicles are filled with eosinophils. Widespread erythematous maculopapular rash usually begins in the first week of life. Individual lesions consist of a white central papule surrounded by erythematous flare. Significance: Mistaken for infection Course and prognosis: Disappears spontaneously

SIMPLE NEVUS
Incidence: Very common seen in 30-50% of infants Clinical features: Bright pink macular capillary hemangioma seen on the neck, bridge of nose, upper lip and eyelids. Simple nevi do not blanch on pressure. Significance: none Course and prognosis: Disappear spontaneously in the first year of life. Those on the neck are usually permanent, but never require treatment.

STRAWBERRY NEVI
Incidence: Common, particularly in preterm infant Clinical features: Dilated capillaries. Raised, soft, pitted, bright red hemangiomas with a discrete edge. Not present at birth. Appear in the first few weeks of life. Significance: Ulceration and infection Course and prognosis: Increase rapidly during the first year of life. Regress slowly over the next years. Eventually disappear leaving a pale depigmented area. Laser surgery done

STURGE-WEBER SYNDROME
Incidence: Not common Clinical features: Sharply demarcated flat capillary hemangiomata. Present at birth and do not increase in size Significance: Vascular malformation of the ipsilateral meninges, cerebral cortex, and eye. Seizure, mental retardation, hemiplegia, and glaucoma. Course and prognosis: The majority remains as permanent discoloration of the skin. Laser surgery.

CONGENITAL PIGMENTED NEVI

Incidence: Not common Clinical features: Severe cosmetic deformity may occur. Significance: 2-10% lifetime risk of malignant melanoma. Course and prognosis: Surgical management and skin grafting.

SCALING DISORDERS OF THE SKIN

EPIDERMOLYSIS BULLOSA
Incidence: Very rare. Autosomal recessive Clinical features: Bullae present soon after birth and cover large areas of the body. Appear after minor trauma. Blisters appear between the basement membrane of the epidermis and the connective tissue of the dermis. Significance: mistaken for staphylococcal infection. Course and prognosis: Good nursing care. Minimal handling, Antibiotics for secondary infection. High mortality in neonatal form.

HARLEQUIN FETUS AND COLLODION BABY

Incidence: Very rare Clinical features: At birth, the infant is encased in a shiny, cellophane like membrane, which will distort the facial features and extremities. Deep fissures are present between scale like areas of skin Significance: fluid and electrolyte imbalance Course and prognosis: Desquamation of the membrane. Lubrication of the skin with creams. Secondary infection. Few develop icthyotic skin changes.

IATROGENIC INJURIES

INFUSION INJURIES
Incidence: Common Clinical features: Ischaemic necrosis. Transient cyanosis of the leg is seen after UAC placement. Cyanosis of the toes. Absence of arterial pulsations Significance: Infection. NEC. Tissue necrosis. Course and prognosis: Tissue necrosis lead to ulceration and later scar formation.

PERINATAL INFECTIONS

STAPHYLOCOCCAL INFECTION
Incidence: Uncommon Clinical features: Small pustules anywhere on the body. Cellulitis. Toxic epidermal necrolysis (TEN) with extensive epidermal separation. Significance: Septicemia, meningitis and osteomyelitis. Course and prognosis: All superficial infection treated with broad-spectrum antibiotics after appropriate swabs and cultures.

CYTOMEGALOVIRUS
Incidence: 1% of the newborns Clinical features: When the mother is infected she usually has only a mild flu like symptoms. Purpura, hepatosplenomegaly. Jaundice periventricular calcifications and pneumonia. Significance: Microcephaly, deafness, and epilepsy. Course and prognosis: 5% develop deafness, and 1% show serious neurological manifestations

CANDIDA
Incidence: Superficial infection of the mouth or perineum is extremely common Clinical features: In the mouth appears as white plaques which cannot be wiped off without causing bleeding. Perineal infection gives a bright red confluent rash in the groin area. Typical satellite lesions lying peripheral to the confluent rash Significance: Fatal systemic infection occurs in preterm infants Course and prognosis: Topical Nystatin. Systemic antifungal agents

NEONATAL HERPES INFECTION

Incidence: Uncommon Clinical features: A generalized vesicular eruption occurs. Systemic disease with involvement of the lungs, liver, gastrointestinal tract and brain. Significance: encephalitis associated with high mortality. Recurrence for up to 5 years Course and prognosis: High risk of neurological abnormality and mental retardation amongst survivors. Systemic antiviral therapy may be helpful if started early. Elective cesarean sections if active lesions are present.

CHICKENPOX
Incidence: Common. The fetus will be immune if the mother has had chickenpox. Serious neonatal illness will occur if mother develops rash within 48 hours of delivery Clinical features: Develop vesicles. Pneumonia. Purpura fulminance. Significance: encephalitis associated with high mortality. Course and prognosis: Infant may rarely have scars. Hyperimmune globulin should be administered to the infant. Acyclovir to reduce the risk of complications.