Chapter 103 - Neonatal Dermatology Flashcards
(102 cards)
1
Q
Greatest risk for systemic toxicity from topically applied substances
A
Premature infants
2
Q
Preterm infants are born ____ weeks of gestation
A
Before 37
3
Q
Full term infants are born between ____ weeks of gestation
A
37 and 42
4
Q
By ___ week, epidermis begins to develop
A
6th
5
Q
By ___ week, there is stratification of fetal epidermis
A
8th
6
Q
By ___ week, DEJ is evident
A
8th
7
Q
By ____ week, terminal differentiation of skin appendages
A
11th and 15th
8
Q
By ____ week, hair follicles will begin to develop
A
14th
9
Q
By ____ week, organization into papillary and reticular dermis occurs
A
15th week
10
Q
By ____ week, there is sebaceous gland formation
A
16th
11
Q
By ____ week, lanugo hair production starts
A
18th
12
Q
By ____ weeks, there is terminal differentiation in interfollicular epidermis
A
22 to 24 weeks
13
Q
By ___ weeks, elastic fibers develop
A
22 to 24
14
Q
By ____ weeks, lanugo hair production is complete
A
28
15
Q
Eccrine gland development is completed during ____ but are not function until _____.
A
2nd trimester, after birth
16
Q
Apocrine glanda are functional during ____
A
3rd trimester
17
Q
____ contibutes significantly to lipid composition of vernix caseosa
A
Sebaceous gland products
18
Q
By ____ week, vernix caseosa begins
A
36th
19
Q
It is composed predominantly of water-containing corneocytes in a lipid matrix composed of nonpolar lipids such as sterol esters and TGL
A
Vernix caseosa
20
Q
Vernix caseosa contains multiple antimicrobial peptides (3)
A
LL37
Cystatin A
Calgranulin
21
Q
Evaluation of ff parameters (4) to indicate continuous adjustment of neonatal skin to extrauterine environment:
A
Skin thickness
Skin pH
Transepidermal water loss
Stratum corneum hydration
22
Q
In full term neonates, TEWL is equivalent to adults except for ____ where TEWL is higher and contibute to impaired barrier function
A
Diaper area
23
Q
One of the most visible early manifestation of adaptive process is
A
Desquamation of upper layers of stratum corneum
24
Q
During the first ___ months of life, the thickness of stratum corneum ____, and the epidermal thickness ____, aong with formation of _____(2)____
A
3 Decreases Increases 1. Dermal papilla 2. Epidermal ridges
25
Normal skin pH is acidic due to (2)
1. Production of free fatty acids from phospholipids
| 2. Production of sweat and sebum
26
In both term and preterm neonate, skin pH is initially more alkaline.
True or False
True
27
Ecrrine sweating is delayed both in term and preterm neonates.
True or False
False, delayed only in preterm
28
TEWL ___ with decreasing gestation
Increases
29
Functional maturation of stratum corneum begins by ____ of gestational age
24
30
Use of radiant warmers and phototherapy also contibute to ___ TEWL
Increased
31
Impaired epidermal barrier infection places preterm infant at risk for
(5)
```
Poor thermoregulation
At risk for electrolyte imbalances
Dehydration
Infection
Increased absorption of topical agents
```
32
Increased skin fragility is also noted in term infants.
| True or False
False, preterm
33
Application of petrolatum has been beneficial by decreasing TEWL but has been associated with ___fold increase in incidence of systemic candidiasis in extremely LBW infants (
3, 1000
34
Neonates receiving petrolatum based emollient therapy should be carefully monitored for infections, particularly very low birthweight infants (< ___g)
1500
35
Recommendations for bathing in skin care include
Bathing in water 2-3 times per week for no more than 5-10 minutes
Make use of soap free cleanser
Application of emollient after bathing
36
Use of skin cleanser has no effect on TEWL, skin surface pH, stratum corneum hydration
True or False
True
37
Preterm neonates can have local or systemic toxicity from soap, lotions or other cleansing solutions.
True or False
True
38
Transient dermatoses of neonate usually resolve by ____ days of age
30
39
Result from subQ edema over presenting part of the head owing to pressure against the cervix
Caput succedaneum
40
Soft to palpation with ill defined borders
Caput succedaneum
41
(+) petechia and ecchymoses
Caput succedaneum
42
Edema resolves spontaneously over 7-10days
Caput succedaneum
43
Results from rupture of diploic and/or emissary veins and subsequent subperiosteal collection of blood
Cephalohematoma
44
It is associated with birth trauma ;use of vacuum extraction vaginal delivery
Cephalohematoma
45
Does not cross the suture lines
Cephalohematoma
46
Unilateral, firm to palpation
Cephalohematoma
47
Underlying skull fracture may be present in caput succedaneum.
True or False
False, cephalohematoma
48
Associated with birth trauma
Cephalohematoma
| Subgaleal hemorrhage
49
Bleeding between the periosteum of skull and galea due to damage of emissary veins
Subgaleal hemorrhage
50
Extensive hemorrhage leading to anemia and neonatal hyperbilirubinemia
Cephalohematoma
| Subgaleal hemorrhage
51
May result into hypovolemic shock or disseminated intravascular coagulation
Subgaleal hemorrhage
52
Pinpoint to 2mm papules representing benign superficial epidermal inclusion cysts commonly on face in newborns
Milia
53
Milia in the oral cavity are called
Epstein pearls
54
Milia resolves spontaneously within a few weeks of life.
| True or False
True
55
Minute (<1mm) yellow macules or papules commonly seen at the opening of pilosebaceous follicles over nose and central forehead of term newborns
Sebaceous gland hyperplasia
56
At least ____% of normal newborns have sebaceous gland hyperplasia
50
57
Sebaceous gland hyperplasia resolves spontaneously by ____ mos of age
4 to 6
58
Sebaceous gland hyperlasia occur secondary to _____
Maternal androgen stimulation
59
It is an idiopathic skin condition seen in up to 75% of term newborns in 24-48 hours of age but may be delayed up to 7-10 days
Erythema toxicum neonatorum
60
Characteristic of ETN
Blotchy erythematous patches (1-3cm) with (1-4mm) central vesicle or pustule
61
ETN vs TPNM
1. Appear at birth
2. Appear at 24-48 hours of age
3. May be delayed until 10 days of age
4. May appear as late as 3 weeks of age
5. Disappear in 5-7 days
6. Clears spontaneously by 2-3 weeks
7. Without residua
8. Peripheal blood eosinophilia
9. Predominance of neutrophils on Wright stained specimens
10. Spares palms and soles
1. 4. 5. 9- TPNM
| 2. 3. 6. 7. 8. 10.- ETN
62
Follicular based lesions are characteristic of TPNM
| True or False
False, ETN
63
It is characterized by multiple superficial vesicles and pustules, with ruptured lesions evident as collarette of scale; prevalent in newborns with darkly pigmented skin
Transient Neonatal Pustular Dermatosis
64
Lesions can occur anywhere but are common on the forehead and mandibular area and may involve palms and soles often disappearing in ___
Transient Neonatal Pustular Dermatoses; 5-7 days
65
Minute superficial subcorneal vesicles
Miliaria crystallina
66
Common disorder that results from fever or overheating
Miliaria or Heat rash
67
Possible causes of miliaria crystallina
1. Eccrine gland occlusion by sweat
Or
2.extracellular polysaccharides of Staphylococcus epidermidis
68
Blotchy or lace like pattern of dusky erythema over trunk and extremities of neonates that occur with exposure to cold environments and disappears with rewarming
Mottling
69
physiologic mottling is due to
Immature autonomic control of cutaneous vascular plexus
70
Physiologic mottling disappears with rewarming, differntiating it from
Cutis marmorata telangiectatica congenita
| Livedo reticularis
71
It is a condition wherein when the neonate is placed on one side, an erythematous flush with sharp demarcation at midline develops on dependent side and the upper half of the body becomes pale
Harlequin color change
72
Harlequin color change is a rare vascular phenomenon that occurs in full term newborns
True or False
True, also in preterm, LBE infants exposed to hypoxia or prostaglandins
73
Harlequin color change may persist for as long as ____ but seldom seen after ____; if persistent there might be an underlying neurologic disorder
20 mins; 10 days of age
74
Neonatal acneiform facial lesions occur in ___ % of newborns
50
75
Most common neonatal acneiform eruption attributed to overgrowth of Malassezia
Neonatal cephalic pustulosis
76
Treatment for neonatal cephalic pustulosis
Ketoconazole topical
77
True infantile acne can be distingushed from neonatal cephalic pustulosis with: (4)
Age of onset
Presence of comedones
Acneiform cysts
Scars
78
Blue gray patches located on lumbosacral area or buttocks: seen in ___% of infants of color and 5% of white infants
Mongolian spots; dermal melanocytosis
| 80-90%
79
Solitary or few well-demarcated tan macules or oatches
Cafe-au-lait macules
80
Multiple CALMs should raise possibility of
NF1
81
A large geographic CALM with ‘coast of Maine’ appearance is mot likely a marker for
McCune-Albright syndrome
82
Tardive congenital melanocytic nevi may appear any time before ___
2 years old
83
CMN enlarge proportionally with age and is expected to increase:
___ on the head
___ on the lower extremities
___ on other sites
1. 7x on head
3. 3x on lower extremities
2. 8x on other sites
84
```
CMN are classified based on size:
Small:
Medium:
Large:
Giant:
```
```
Small:<1.5cm
Medium
M1 1.5 to 10cm
M2 11-20cm
Large
L1 21-30cm
L2 31-40cm
Giant
G1 41-60 cm
G2>60cm
```
85
Risk factors for neurocutaneous melanocytosis
1. Large or giant CMN with posterior axial location or if
2. More than 20 satellite nevi are present
3. Newborns with more than 2 medium sized CMNS
86
Complications of large or giant CMN
Melanoma
| Neurocutaneous melanocytosis
87
Complications of neurocutaneous melanocytosis
Obstructive hydrocephalus
| Primary CNS melanoma
88
Pigmentary mosaicism or patterned dyschromatosis crosses the midline.
True or False
False, does not cross
89
3 or more nevus depigmentosus should prompt evaluation for
Tuberous sclerosis
90
Nevus anemicus vs nevus depigmentosus
1. Borders of lesion remain crisp with diascopy
2. Borders of lesion disappear with diascopy
3. Hypersensitivity to catecholamines
Nevus depigmentosus 1.
| Nevus anemicus 2. 3.
91
Superficial vascular ectasia of capillaries found on glabella, upper eyelids, nuchal area
Nevus simplex
92
Salmon patch, stork bite, angel kiss fade over the first ____ years of life
2
93
Nevus simplex occurs in high frequency in all races.
____% of white infants
____% of black infants
70% of white
| 59% of black
94
Majority of nevus simplex birthmarks fade, except for those on ____
Occiput
95
Most common tumors of infancy
Infantile hemangioma
96
Benign neoplasms (2) that occur within a nevus sebaceus
Trichoblastoma
| Syringocystadenoma papilliferum
97
Widespread nevus sebaceus + increased risk of abnormalities in the CNS, eye, or skeletal symptoms
Schimmelpenning syndrome
98
Epithelial ectoderm separates from neural ectoderm by ___AOG
3rd- 5th
99
Milia when persistent may be associated with ff disorders
Bazex Dupre Christol
100
Peripheral blood eosinophilia may occur in ___% of ETN patients and associated with numerous lesions
20
101
Solitary intact oval or linear blisters, superficial erosions, or crusts, arising on noninflamed skin
Sucking blisters
102
Neurocutaneous melanocytosis RF
Posterior axial location
More than 20 satellite nevi
More than 2 medium sized congenital nevi
