{"id":1531,"date":"2023-01-18T18:10:10","date_gmt":"2023-01-18T23:10:10","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/?post_type=chapter&p=1531"},"modified":"2023-01-18T18:13:02","modified_gmt":"2023-01-18T23:13:02","slug":"potentially-concerning-skin-changes-in-newborns","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/chapter\/potentially-concerning-skin-changes-in-newborns\/","title":{"raw":"Potentially Concerning Skin Changes in Newborns","rendered":"Potentially Concerning Skin Changes in Newborns"},"content":{"raw":"

Blisters<\/span><\/span><\/h1>\r\nBlisters<\/span><\/span> can occur in neonates or a variety of reasons including infection, genetic blistering diseases (see Epidermolysis bullosa), and infiltration of the skin with mast cells. Appropriate testing to rule out infection is necessary and proper wound care is crucial to prevent secondary bacterial infection. <\/span><\/span>\u00a0<\/span>\r\n

Neonatal Herpes Simplex<\/span><\/span><\/h1>\r\nNeonatal herpes simplex<\/span><\/span> usually presents<\/span> with v<\/span>esicles and occurs due to HSV exposure during vaginal delivery. <\/span>Vesicles are seen most commonly on the presenting part of the baby such as the crown of the head. Neonatal HSV is more likely if the mother is experiencing her first episode of HSV, so she might not have a history of genital herpes. <\/span>The rash may be present from birth<\/span> if it is acquired <\/span><\/span>in utero<\/span><\/span> but typically starts at least 5 days after birth. Infection may be complicated by encephalitis, and mortality is ~50% in these cases if not treated with <\/span>IV <\/span>acyclovir.\u00a0<\/span><\/span>\u00a0<\/span>\r\n

Neonatal Lupus<\/span><\/span><\/h1>\r\nNeonatal lupus<\/span><\/span> is seen in babies born to mothers with <\/span>anti-Ro<\/span>, anti-La, or U1RNP antibodies. The antibodies can cross the placenta and cause changes in the baby. Skin findings include annular plaques with fine scale especially on the head and neck and concentrated around the eyes. The lesions typically first appear by <\/span>2 <\/span>months of age and worsen after sun exposure. <\/span>While skin changes will self-resolve, babies with neonatal lupus are at risk for heart block, <\/span>cytopenias<\/span>, and liver function changes.\u00a0\u00a0<\/span><\/span>\u00a0<\/span>\r\n\r\n \r\n\r\n[caption id=\"attachment_378\" align=\"aligncenter\" width=\"300\"]\"\" Image 2.4: Annular plaques of NLE on the feet. More typical location is the face.[\/caption]\r\n

Collodion Membrane<\/span><\/span><\/h1>\r\nCollodion membrane <\/span><\/span>is the name given to a parchment or plastic wrap-like membrane of skin that wraps some newborns.\u00a0 It can cause ectropion and\/or eclabium.\u00a0 It may be the first sign of an ichthyosis, but also can be self-resolving. Treatment is with moisturizers, and possibly incubator, to help preserve skin function. The membrane will slough spontaneously and should not be removed.\u00a0<\/span><\/span>\r\n

Subcutaneous<\/span> Fat Necrosis of the Newborn<\/span><\/span><\/h1>\r\nSubcutaneous<\/span> fat necrosis of the newborn <\/span><\/span>occurs due to crystal formation in fat cells in newborn fat. It is seen most often in newborns who have required cooling and presents with tender red-brown nodules. Babies with extensive subcutaneous fat necrosis should not be given Vitamin D and should be followed for possible development of hypercalcemia.\u00a0<\/span><\/span>\r\n\r\n \r\n\r\n[caption id=\"attachment_379\" align=\"aligncenter\" width=\"300\"]\"\" Image 2.5: Tender indurated plaque on the shoulder of a neonate with fat necrosis[\/caption]\r\n\r\n
\r\n

Blueberry Muffin Baby<\/span><\/span><\/h1>\r\nBlueberry muffin baby<\/span><\/span> describes the clinical finding of widespread red to purple papules and nodules in a newborn baby. <\/span>There is a wide range of <\/span>conditions that lead to <\/span>the finding of <\/span>blueberry muffin baby. The most common of these are congenital infections, but different forms of anemia and hematologic malignancy are <\/span>among other<\/span> potential causes.<\/span> Evaluation for underlying cause of the nodules is imperative.\u00a0<\/span><\/span>\u00a0<\/span>\r\n\r\n \r\n\r\nSelected causes of blueberry muffin baby:\r\n\r\n<\/div>\r\n
\r\n
\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
\r\n
Infections\u00a0<\/strong><\/div><\/td>\r\n
\r\n
Anemia and blood loss\u00a0<\/strong><\/div><\/td>\r\n
\r\n
Other\u00a0<\/strong><\/div><\/td>\r\n<\/tr>\r\n
\r\n
Congenital Rubella<\/div><\/td>\r\n
\r\n
Hemolytic Anemia<\/div><\/td>\r\n
\r\n
Leukemia Cutis<\/div><\/td>\r\n<\/tr>\r\n
\r\n
Toxoplasmosis<\/div><\/td>\r\n
\r\n
Twin-twin Transfusion<\/div><\/td>\r\n
\r\n
Neuroblastoma<\/div><\/td>\r\n<\/tr>\r\n
\r\n
Cytomegalovirus<\/div><\/td>\r\n
\r\n
Fetomaternal Hemorrhage<\/div><\/td>\r\n
\r\n
Langerhans Cell Histiocytosis<\/div><\/td>\r\n<\/tr>\r\n
\r\n
Coxsackievirus<\/div><\/td>\r\n
\r\n
Severe Internal Bleeding<\/div><\/td>\r\n
<\/td>\r\n<\/tr>\r\n
Parvovirus<\/td>\r\n<\/td>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n ","rendered":"

Blisters<\/span><\/span><\/h1>\n

Blisters<\/span><\/span> can occur in neonates or a variety of reasons including infection, genetic blistering diseases (see Epidermolysis bullosa), and infiltration of the skin with mast cells. Appropriate testing to rule out infection is necessary and proper wound care is crucial to prevent secondary bacterial infection. <\/span><\/span>\u00a0<\/span><\/p>\n

Neonatal Herpes Simplex<\/span><\/span><\/h1>\n

Neonatal herpes simplex<\/span><\/span> usually presents<\/span> with v<\/span>esicles and occurs due to HSV exposure during vaginal delivery. <\/span>Vesicles are seen most commonly on the presenting part of the baby such as the crown of the head. Neonatal HSV is more likely if the mother is experiencing her first episode of HSV, so she might not have a history of genital herpes. <\/span>The rash may be present from birth<\/span> if it is acquired <\/span><\/span>in utero<\/span><\/span> but typically starts at least 5 days after birth. Infection may be complicated by encephalitis, and mortality is ~50% in these cases if not treated with <\/span>IV <\/span>acyclovir.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

Neonatal Lupus<\/span><\/span><\/h1>\n

Neonatal lupus<\/span><\/span> is seen in babies born to mothers with <\/span>anti-Ro<\/span>, anti-La, or U1RNP antibodies. The antibodies can cross the placenta and cause changes in the baby. Skin findings include annular plaques with fine scale especially on the head and neck and concentrated around the eyes. The lesions typically first appear by <\/span>2 <\/span>months of age and worsen after sun exposure. <\/span>While skin changes will self-resolve, babies with neonatal lupus are at risk for heart block, <\/span>cytopenias<\/span>, and liver function changes.\u00a0\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

\"\"
Image 2.4: Annular plaques of NLE on the feet. More typical location is the face.<\/figcaption><\/figure>\n

Collodion Membrane<\/span><\/span><\/h1>\n

Collodion membrane <\/span><\/span>is the name given to a parchment or plastic wrap-like membrane of skin that wraps some newborns.\u00a0 It can cause ectropion and\/or eclabium.\u00a0 It may be the first sign of an ichthyosis, but also can be self-resolving. Treatment is with moisturizers, and possibly incubator, to help preserve skin function. The membrane will slough spontaneously and should not be removed.\u00a0<\/span><\/span><\/p>\n

Subcutaneous<\/span> Fat Necrosis of the Newborn<\/span><\/span><\/h1>\n

Subcutaneous<\/span> fat necrosis of the newborn <\/span><\/span>occurs due to crystal formation in fat cells in newborn fat. It is seen most often in newborns who have required cooling and presents with tender red-brown nodules. Babies with extensive subcutaneous fat necrosis should not be given Vitamin D and should be followed for possible development of hypercalcemia.\u00a0<\/span><\/span><\/p>\n

 <\/p>\n

\"\"
Image 2.5: Tender indurated plaque on the shoulder of a neonate with fat necrosis<\/figcaption><\/figure>\n
\n

Blueberry Muffin Baby<\/span><\/span><\/h1>\n

Blueberry muffin baby<\/span><\/span> describes the clinical finding of widespread red to purple papules and nodules in a newborn baby. <\/span>There is a wide range of <\/span>conditions that lead to <\/span>the finding of <\/span>blueberry muffin baby. The most common of these are congenital infections, but different forms of anemia and hematologic malignancy are <\/span>among other<\/span> potential causes.<\/span> Evaluation for underlying cause of the nodules is imperative.\u00a0<\/span><\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

Selected causes of blueberry muffin baby:<\/p>\n<\/div>\n

\n
\n\n\n\n\n\n\n\n\n
\n
Infections\u00a0<\/strong><\/div>\n<\/td>\n
\n
Anemia and blood loss\u00a0<\/strong><\/div>\n<\/td>\n
\n
Other\u00a0<\/strong><\/div>\n<\/td>\n<\/tr>\n
\n
Congenital Rubella<\/div>\n<\/td>\n
\n
Hemolytic Anemia<\/div>\n<\/td>\n
\n
Leukemia Cutis<\/div>\n<\/td>\n<\/tr>\n
\n
Toxoplasmosis<\/div>\n<\/td>\n
\n
Twin-twin Transfusion<\/div>\n<\/td>\n
\n
Neuroblastoma<\/div>\n<\/td>\n<\/tr>\n
\n
Cytomegalovirus<\/div>\n<\/td>\n
\n
Fetomaternal Hemorrhage<\/div>\n<\/td>\n
\n
Langerhans Cell Histiocytosis<\/div>\n<\/td>\n<\/tr>\n
\n
Coxsackievirus<\/div>\n<\/td>\n
\n
Severe Internal Bleeding<\/div>\n<\/td>\n
<\/td>\n<\/tr>\n
Parvovirus<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n

 <\/p>\n

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