CH 22 Derm in Infant Flashcards
hemangioma patho
-BENIGN tumor of endothelium
-local proliferative process that affects endothelial cells
-perhaps genetic mutation of epithelial regulation
hemangioma presentation
NOT present at birth
grew rapidly from first days of life to 6 months
-slow proliferation for 6-12 months then involution/shrinks phase from 12 months to 3-6 years
-light port wine stain (1/3 have it)
hemangioma management
-depends on location, risk of complication, scarring, ulceration
-can slow growth with: oral propranolol, systemic corticosteroids
-vinscristine, interferon alpha injection into lesion
-uncommon: injected steroids, laser therapy
-watchful waiting
when would you do watchful waiting for hemangioma?
-for active nonintervention for superficial lesions in low function areas (thigh, upper arm)
-will involute slowly through early childhood
port wine lesion patho
disorder of dermal capillaries and post capillary venules
- can be a/s with other congenital or genetic syndromes (Sturge-Weber (if on face) or AV malformation syndrome)
port wine lesion presentation
ALWAYS present at birth
-blanchable (vascular) from red to dark pink, grows proportionally with child
-will darken and become more nodular as child grows and not regress
-lesions on face follow trigeminal nerve branches
port wine lesion considerations
genetic and congenital syndrome when lesions are present, esp if face and eyelid involved
port wine lesion management
Referrals:
-Derm for pulse dye laser therapy (lightens but doesn’t remove)
-ophthalmology if eyelids involved (glaucoma risk)
-neuro (on face = seizures)
mongolian spot patho
diffuse melanocytes within dermis
- interrupted movement of melanocytes during
fetal development from neural crest to epidermis
mongolian spot presentation
-blue-black-gray macular lesions (lower back, butt mostly)
-single or multiple lesions
NONtender (not bruises), no malignancy potential
-Asian, natives, Africans (rare in europeans)
mongolian spot management
no treatment! lighten over time and often disappear during childhood
milia patho
retention of keratin and sebaceous material in pilosebaceous glands
milia presentation
raised white bumps mainly on nose and cheeks
milia management
no treatment! resolves spontaneously 1-2 months
-reassurance to parents
-don’t pick or remove it = scar
erythema toxicum neonatorum (ETN) path
unknown
-thought to be immaturity of pilosebaceous glands (hair follicles)
erythema toxicum neonatorum presentation
-occasionally at birth, usu appears w/in first 2 days and resolves by day 5-7
-“flea bitten” appearance
-erythematous papules that progress to pustular lesions
atopic dermatits (eczema) patho
-impaired epidermal layer, with impaired barrier = irritants get into dermis
-decreased water content due to poor barrier
-itch-scratch cycle worsens condition
-genetic component
atopic dermatitis management
3 prongs:
1. eliminate triggers
2. hydrate (use thick creams or ointments daily, no lotion bc it dehydrates when it evaporates)
-minimal soap use! bathe only 2-3x/week
-best hydration cream: Crisco cooking fat
3. control itch (sedating antihistamines qhs, topical cortiocs for flares)
acne neonatorum presentation
-face, forehead, nose, cheeks
-starts first months of life, lasting 1-2 months (longer than ETN) til ~4 months w/o scarring
seborrheic dermatitis aka Cradle Cap patho
-usu in areas of dense sebaceous gland (scalp, face, groin, underwarms)
-overstimulation of sebum production
-possibly lipid dependent yeast
keratosis pilaris presentation
-rough skin texture (chicken skin)
- usu asymptomatic except of occasional pruritus
- poor cosmetic appearance
- upper arm most common
- Parents of Asian ancestry bring in
their healthy 1-week-old daughter born
at full term for a well child evaluation.
Upon examination, you notice multiple
non-tender blue-black flat lesions on the
lower back and buttocks. The most likely
diagnosis is:
A. Port wine lesion.
B. Milia.
C. Keratosis pilaris.
D. Mongolian spot.
D Mongolian spots
look like a bruise but it’s NON tender!
african and asian most common
-face and anterior trunk is spared. fades during prescale age
uncommon in europeans
- During a well child visit of a 4-weekold girl, the parents express concern
about raised white bumps on the infant’s
nose and cheeks. The NP recognizes
milia and recommends the following
approach:
A. No specific treatment as this condition
will resolve spontaneously.
B. Softly scrubbing the area twice daily with
a mild moisturizing soap and warm water.
C. Daily application of a low-potency
corticosteroid cream to the affected area.
D. Referral to a pediatric dermatologist.
answer A
Milia is common in young babies and will go away on it’s own. Discourage any picky = scarring or steroid use.
Treatment of atopic dermatitis / eczema present
on the cheeks and mouth of an
otherwise healthy 4-month-old infant can include all of the following except:
A. Moisturizing cream to hydrate the skin.
B. Oral antihistamines to reduce itching.
C. Topical antimicrobial to prevent infection.
D. An appropriate potency topical
corticosteroid to control flares.
C don’t need antibiotics!!!
- Hydration
- LOW potenency for flares for short period of time.
- Oral antihistamines for itchiness good!
ecezma on face is most like in the young child
drooling ~ 4 months irritates eczema
doesn’t matter what part of body, moisturizing is key!
