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Most popular medical Questions
What should the family of a newborn with a yellow, hairless patch with a cobblestone texture be advised to do?The lesion is likely a nevus sebaceous. This hamartomatous neoplasm usually presents as a yellow-pink hairless plaque on the scalp or face at the time of birth and is composed primarily of malformed sebaceous glands. Under the influence of androgens at puberty, the glands may hypertrophy and lead to the development of other neoplasms (e.g., basal cell carcinoma). The risk of neoplastic (usually benign) development is 10-15%. Some experts advise excision during the preteen, prepubertal years. Careful monitoring of the lesion for new growths or nonhealing ulcerations at all ages is advised, especially during adolescence.
Aplasia cutis congenita of the scalp may be associated with which chromosomal abnormality?
Aplasia cutis congenita (congenital absence of the skin) presents on the scalp as solitary or multiple well-demarcated ulcerations or atrophic scars. Of variable depth, the lesions may be limited to epidermis and upper dermis or occasionally extend into the skull and dura. Although most children with this lesion are normal without multiple anomalies, other associations include epidermolysis bullosa, placental infarcts, teratogens, sebaceous nevi, and limb anomalies. Aplasia cutis is a feature of trisomy 13 syndrome.
Describe the appearance and distribution of transient neonatal pustular melanosis.
Consisting of small vesicopustular lesions 3-4 mm in size, transient pustular melanosis occurs in almost 5% of black and 1% of white newborns. It may be present at birth or appear shortly after birth. The lesions most often cluster on the neck, chin, palms, and soles, although they may occur on the face and trunk. The pustules rupture easily and progress to brown, pigmented macules with a fine collarette of scale. Microscopic examination of the contents of the pustules reveals neutrophils with no organisms. There are no associated systemic manifestations, and the eruption is self-limited, although the hyperpigmentation may last for months.
Is erythema toxicum neonatorum really toxic?
Not in the least. Erythema toxicum is a common eruption composed of erythematous macules, papules, and pustules that occur in newborns, usually during the first few days of life. The lesions may start as irregular, blotchy, red macules, varying in size from millimeters to several centimeters. They often develop into 1-3-mm, yellow-white papules and pustules on an erythematous base, giving a "flea-bitten" appearance. They occur all over the body except on the palms and soles, which are spared because the lesions occur in pilosebaceous follicles, which are absent on the palmar and plantar surfaces. The rash is less common in premature infants, with incidence proportional to gestational age and peaking at 41-42 weeks. Although it may be seen at birth, it is most common during the first 3-4 days of life and is occasionally noted as late as 10 days of life. Erythema toxicum usually lasts 5-7 days and heals without pigmentation. Other than the rash, the newborn appears healthy.
How is the diagnosis of erythema toxicum confirmed?
Erythema toxicum is often confused with a variety of other skin disorders, including impetigo neonatorum, herpes simplex, transient neonatal pustular melanosis, milia, and miliaria. The diagnosis can be confirmed by staining the contents of a pustule with Wright or Giemsa stain. Clusters of eosinophils confirm the presence of erythema toxicum.
For academic purposes (and ICD-9-CM coding), is it possible to be more scientific about the diagnosis of "prickly heat"?
The scientific name for this condition is miliaria rubra. It is due to sweat retention, and its clinical morphology is determined by the level at which sweat is trapped. Sweat trapped at a superficial level produces clear vesicles without surrounding erythema (sudamina or crystallina); miliaria rubra (prickly heat, erythematous papules, vesicles, papulovesicles) is produced by sweat trapped at a deeper level; pustular lesions (miliaria pustulosa) and even abscesses (miliaria profunda) are produced with sweat retention at the deepest of levels (infants rarely develop these types). With the advent of air conditioning, miliaria rarely occurs in newborn nurseries.
A skin scale that easily bleeds on removal is characteristic of what condition?
The appearance of punctate bleeding points after removal of a scale is the Auspitz sign. It is seen primarily in psoriasis and is related to the rupture of capillaries high in the papillary dermis, near the surface of the skin.
What percentage of children with psoriasis have nail involvement?
Nail changes, most commonly pitting, may be the only manifestation of psoriasis. The reported incidence of nail pitting in children with psoriasis is as high as 40%. Other nail changes include onycholysis (separation of the nail plate from nailbed at the distal margin) and thickening of the nail plate, often with white-yellow discoloration. Subungual debris may occur.
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