Newborn Skin

- Sweat glands do not achieve full functioning at until 2-3 year of life
- In utero, fetal skin covered with vernix caseosa, (greasy yellow-white), composed of sebaceous gland secretions and skin cells. Present during 3rd trimester, decreasing as approaches 40 weeks term.
- In utero, lanugo appears at 20 weeks gest, and covers most of body incl face. Most disappears by 40 weeks.
- Begin at head, progress to feet... inspect back and all crevices incl axillae, groin
- Check for pitting edema, pinch skin to see if loose skin folds are there, indicating decreased subq fat
- Derm terminology


Common variations in newborn skin

  1. acrocyanosis
  2. plethora
  3. jaundice, general
  4. cutis marmorata
  5. harlequin color change

Common Newborn skin lesions

  1. Erythema Toxicum
  2. Milia
  3. Sebaceous Gland Hyperplasia
  4. Milaria
  5. Sebaceous Nevus

Common Pigmented Lesions

  1. Hyperpigmented Macule (Mongolian Spot)
  2. Transient Neonatal Pustular Melanosis
  3. Pigmented Nevus
  4. Cafe Au Lait patches
  5. Tuberous Sclerosis

Skin Lesions Secondary to Trauma

  1. Forcep Marks - look for other birth trauma ie facial palsy, fractured clavicles, skull fx
  2. Subcutaneous Fat Necrosis
  3. Sucking blisters - vesicles/bullae on lips/fingers/hands, due to vigorous sucking in utero/after birth. No tx
  4. Scalp lesions - delivery trauma, scalp electrode, suction cup, scalp pH. Clean and dry. Watch for secondary infxn.

Vascular Skin Lesions

  1. Nevus Simplex
  2. Port Wine Nevus (Nevus Flammeus)
  3. Strawberry Hemangioma
  4. Cavernous Hemangioma

Infectious Lesions

  1. Thrush
  2. Candida diaper dermatitis
  3. Neonatal Herpes
  4. Staph scalded skin syndrome
  5. Other Congenital viral infections - rubella, CMV... usually with jaundice, petechiae, purpura seen on head, trunk extremities. Blueberry muffin spots caused by thrombocytopenia and dermal erythropoesis. HSM is often present.
  6. Neonatal Candidiasis

Miscellaneous Skin lesions

  1. Cutis aplasia

Nails

  1. absence or atrophy of nails - in congenital syndromes: tris 13, tris 18, turner,
  2. hypertrophy of nails - rarely seen in nbn period. may occur in congenital hemihypertrophy or familial oncychogryposis
  3. abnormally shaped nails: spoon/raquet shaped (congenital or hereditary), may be assoc w/ anomalies of hair/skin. Spoon nails may be a temporary finding in a healthy kid.