SKIN DISORDERS IN

NEONATES
 Pembimbing : dr. Syahriani Syahrir, M.Kes, Sp.KK

DISUSUN UNTUK MEMENUHI TUGAS KEPANITERAAN KLINIK

PADA BAGIAN ILMU DERMATOLOGI DAN VENEROLOGI
PROGRAM STUDI PENDIDIKAN DOKTER
FAKULTAS KEDOKTERAN
UNIVERSITAS AL-KHAIRAAT
PALU
2016
 Skin In Neonatus

Royal Prince Alfred Hospital

Newborn Car

Stratum corneum at 26 weeks gestation compared with an infant born at term. TEWL decreases
with increasing post natal age and while acceleration in the maturation of the stratum corneum
occurs after birth, TEWL for infants less than 27 weeks still remains more than twice as high as
their term counterparts at four weeks postnatal age
Difference neonatal and adult skin

Australian Medical Student

Journal
 Sebaceous hyperplasia
Approximately 50% of newborns have sebaceous gland
hyperplasia.
It is less common in preterm.
Multiple, tiny, yellowish papules are seen at the
opening of each pilosebaceous follicle in areas in which
sebaceous glands are abundant such as nose, cheeks,
upper lip and forehead.
Sebaceous hyperplasia results from the influences of
maternal androgens on the pilosebaceous follicle.
This is a benign condition
Resolves spontaneously by 4-6months of age

Fitzpatricks 2012
Figure 1. Yellowish papul, miliar

Fitzpatricks 2012
Differential Diagnosis

Figure 2. Milia
 Transient Neonatal Pustular Melanosis.
TNPM is an idiopathic pustular eruption of the newborn that heals
with tiny brown-pigmented macules
It is less common than ETN and is more prevalent among newborns
with darkly pigmented skin.
Lesions are usually present at birth or shortly thereafter, but may
appear as late as 3 weeks of age, as superficial vesicles and pustules,
with ruptured lesions evident as collarettes of scale.
Pigmented macules are also often present at birth or develop at the
sites of resolving pustules or vesicles within hours or
during the first day of life
Lesions can occur anywhere but are common on the forehead and
mandibular area, the palms and soles.
The pustules usually disappear within 57 days of age, leaving
residual pigmented macules that resolve over 3 weeks to 3 months.
Fitzpatricks 2012
Figure 3. (left) Pustul with cristally color and when it heals brown
pigmented that resolve over 3 weeks to 3 months.

Fitzpatricks 2012
Differential diagnosis

Figure 4. Miliaria rubra

 Harlequin color change
Harlequin color change is a rare vascular phenomenon occurring in
Low-birthweight infants.
When the infant is placed on one side, an erythematous flush with a
sharp demarcation at the midline develops on the dependent side,
and the upper half of the body becomes pale.
The exact mechanism of this unusual phenomenon is not known, but
it may be due to immaturity of autonomic vasomotor control.
Harlequin color change is seldom seen after 10 days of age.

Fitzpatricks 2012
Valerio, 2015
Figure 5. The color change seen in half of the face and scrotum usually
subsides within a few seconds of placing the baby in the supine position
but may persist for as long as 20 minutes.

Valerio, 2015
 Caput Succedaneum and
Cephalhematoma
Caput succedaneum is subcutaneous edema over the
presenting part of the head and is a common
occurrence in newborns.
Cephalohematoma is a subperiosteal collection of
blood and is less common. Both lesions are due to
shearing forces on the scalp skin and skull during
labor.
Both caput succedaneum and cephalohematoma
resolve spontaneously

Fitzpatricks 2012
Figure 6. If more than one bone is affected, there will be a separation
between the two areas the suture line. the sagittal suture separates the
bilateral parietal cephalohematomas.

Fitzpatricks 2012
Paller, 2016
Figure 7. After the pressure is released, the pitting indentation is clearly
seen. Although caput can cross over suture lines (if it affects the scalp),
it is often predominently unilteral.

Fitzpatricks 2012
Paller, 2016
 Benign cepalic pustulosis

Neonatal acneiform facial lesions

Usually develop within the first 30 days of life and
are estimated to occur in 50% of Newborns
This benign eruption appears with elevation DHEA
(Dehydroepiandrosterone)
Overgow Malassezia sp
Resolve spontaneously, but the eruption can be
treated topically with ketoconazole, benzoyl
peroxide, or erythromycin.

Fitzpatricks 2012
Figure 8. Benign cephalic pustulosis. Tiny papulopustules withou
comedons

Kansal, 2015
Differential diagnosis

Figure 9. Neonatal acne

 MILIA

Milia are multiple pinpoint to 1 mm papules

representing benign, superficial keratin cysts.
Most commonly on the nose of infants and
may be present in the oral cavity (Epsteins
pearls).
Resolve spontaneously within a few weeks of
life.
Differentian diagnostic is neonatal acne

Fitzpatricks 2012
Figure 10. Papules in milia

Buonocore, 2012
 Differential Diagnostic

Figure 11. Neonatal acne Manifested by multiple, inflammatory,

erythematous papules, comedones, and pustules
 Erythema Toxicum Neonatorum
ETN is a blotchy erythematous macules 1-3 cm
diameter with vesicle or pustule in central.
Idiopathic in 75% of term newborns
The lesions can be located anywhere but tend
to spare the palms and soles.
ETN is benign and clears spontaneously by 2-3
weeks of age.
Differentian diagnostic with Transient
neonatal pustular melanosis

Fitzpatricks 2012
Serdaloglu, 2008
Figure 12. Erythematous macules with vesicle or pustules in
central

Fitzpatricks 2012
 Differential Diagnostic

Figure 13. Hyperpigmented macules Transient neonatal

pustular melanosis
 Mottling

Mottling is a blotchy or lace-like pattern of

dusky erythema over the extremities and
trunk of neonates.
Mottling is resolves spontaneously by 6 month
of age.
Differentian diagnostic with Cutis memorata
talangiectatica congenita

Fitzpatricks 2012
Pride, 2008
Figure 14. blotchy or lace-like pattern of dusky erythema

Oconnor, 2008
 Differential Diagnostic

Figure 15. Cutis memorata talangiectatica congenita

 Sucking Blisters
Sucking blisters is blisters that occur at birth
due to intrauterine suction.
More commonly seen during the first week of
life.
Usually solitary, intact oval or linear blisters,
erosions or drying crusts.
In skin of the dorsal-radial aspect of forearms,
wrists, or fingers or on the upper lip.
Differentian diagnostic with bullous impetigo

Fitzpatricks 2012
Figure 16. Blisters in upper lip

Pride, 2008
Differential Diagnostic

Figure 17. Bullous impetigo

 Conclusion
Infants are born with a developing epidermal
barrier. The skin is structurally and functionally
immature at birth.
Thankyou