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Close-up of the lesions in erythema toxicum neonatorum. The etiology is unknown but biopsy of the lesions show the presence of numerous eosinophils. It has been suggested that the presence of erythema toxicum is evidence of maturity. Figure 1.27. Lentigines are smooth, freckle-like, pigmented macules. They are usually present at birth, have a scattered distribution, and have been considered by some to be a manifestation of intrauterine erythema toxicum neonatorum. They usually...

Picture Of Port Wine Stain Of Newborn

Capillary Bleeding Images

This infant shown in Figure 1.114, now at the age of 3 months, developed a cystic swelling over the scalp in the first few weeks of life. The cystic swelling increased gradually in size note the bluish hue. On removal this was confirmed to be a strawberry hemangioma. Note that strawberry hemangiomas may have a large component visible on the surface of the skin, or may be covered by the skin, thus obscuring their characteristic appearance. Figure 1.116. In some infants the lesion...

Scaling Disorders

Lamellar Ichthyosis

Different abnormalities of the stratum corneum are included under the general heading ichthyosis. These conditions all involve faulty keratinization. The name is derived from the small plates of thickened epidermis yielding a pattern similar to the scales of a fish. Figure 1.215. This postmature infant is an example of a so-called collodion baby. Collodion babies are seen in postmaturity, lamellar ichthyosis, and congenital ichthyosiform erythroderma. The term collodion is used because of the...

Perinatal Infection

Rubella Virus

The immediate and long-term effects of perinatal infection are a major problem throughout the world. Perinatal infection is relatively common among the over 4 million births per year in the United States but the incidence is dependent upon the organism. One percent of newborn infants excrete cytomegalovirus. Fifteen percent are infected with Chlamydia trachomatis one-third develop conjunctivitis and one-sixth, pneumonia. One to eight per 1,000 live births develop bacterial sepsis. In utero or...

Other Dermatologic Problems

Infants With Abnormal Big Head

The typical facies of hypohidrotic anhidrotic ectodermal dysplasia is seen in this infant. Note the alopecia, absent eyebrows and eyelashes, square forehead with frontal bossing, hyperpigmented wrinkles around the eyes, flattened nasal bridge, and large conspicuous nostrils. There are wide cheek bones with depressed cheeks, thick everted lips, a prominent chin, and the ears may be small and pointed. These infants have a thin dry skin, decreased sweating, decreased tearing, and...

Gangrene Infection

Cellulitis Gangrene

This infant has necrotizing fasciitis of the abdominal wall, which is a rapidly progressive acute necrotizing infection of the skin, subcutaneous tissue, muscle, and fascia. Necrotizing fasciitis usually presents as an area of cellulitis with fever, redness, and edema. It rapidly progresses to central patches of bluish discoloration followed by ulceration, gangrene, and toxicity. Necrotizing fasciitis is a surgical emergency as it is rapidly fatal if not treated aggressively by...

Ophthalmia Neonatorum

Ophthalmia Neonatorum

This infant with streptococcal sepsis developed cellulitis over a prominent xiphoid process. Figure 2.37. This infant with streptococcal sepsis developed cellulitis over a prominent xiphoid process. Figure 2.38. Gonococcal ophthalmia neonatorum in an infant at the age of 4 days. With prophylaxis this disease is rarely seen today. The most common cause of neonatal ophthalmia at the present time is staphylococcal infection.

Listeria Skin Newborn

Cutaneous Listeriosis

Close-up of die skin lesions of die same infant as in Figure 2.42. Note the macules, papules and vesicles. In the septicemic form of listeriosis, a cutaneous eruption of miliary abscesses resembling papules, pustules, or papulo-pustules may occur over the entire body with a predilection for the back. Culture of the lesions, the blood, or cerebrospinal fluid usually reveals Listeria monocytogenes as the offending agent. Figure 2.43. Close-up of die skin lesions of die same infant as...

Newborn Has Skin Tags In Mouth

Skin Tag Near Mandible Newborn

Vestigial tails are rarely seen in the neonate. They may consist of soft tissue only, as in this infant, or may contain osseous structures. Figure 1.74. Note the preauricu-lar and facial skin tags in this otherwise normal infant. Preauricular skin tags are extremely common, but the presence of skin tags between the ear and comer of the mouth would suggest a diagnosis of Goldenhar's syndrome. Figure 1.74. Note the preauricu-lar and facial skin tags in this...

Pseudomonas Cellulitis

Pseudomonas Sepsis

In the same infant as in Figure 2.47 and 2.48, the infraclavicular lesion broke down with severe damage to the underlying subcutaneous tissue and muscle ulceration developed this healed with scarring over time. Note the lesion at the age of 37 days. Figure 2.50. The same infant as in Figure 2.47 to 2.49 at the age of 57 days showing the lesions with breakdown and healing on the back. Figure 2.51. Typical fried egg appearance necrotic center with surrounding inflammation of skin...

Neurologic Sequelae Newborns

Dermal Erythropoiesis

A close-up of the head and face of the same infant as in Figure 2.91 with microcephaly and the typical blueberry muffin lesions. These lesions represent areas of dermal erythropoiesis. Cutaneous manifestations include petechiae, purpura, blueberry muffin lesions also seen in congenital rubella and other conditions , and vasculitis. Figure 2.91. This infant with cytomegalovirus infection has a low birthweight due to intrauter-ine growth retardation and shows the blueberry muffin...

Viral Infection

Coxsackie Virus Viral Structure

This infant at age 5 days developed fever, lethargy and poor feeding. On sepsis evaluation there was a pleocytosis of 120 WBCs in the cerebrospinal fluid indicative of meningoen-cephalitis. There was no evidence of cardiac involvement. The following day the infant developed a generalized maculopapular rash and loose stools. He recovered without treatment. Stool culture grew Coxsackie virus. Figure 2.89. This infant at age 5 days developed fever, lethargy and poor feeding. On sepsis...

Hydrops Fetalis

Photos Hydrops Fetus Weeks

Nonimmune hydrops fetalis due to parvovirus B19 infection in a premature infant born at 24 weeks gestation. Note the gross hydrops fetalis. Laboratory analysis was remarkable for a hemoglobin level of 1.4 g dL, hematocrit of 4 , platelet count of 10,000 mm3, and WBC count of 6000 mm3 which, when corrected for nucleated red blood cells, showed a WBC count of 0 . Figure 2.117. Nonimmune hydrops fetalis due to parvovirus B19 infection in a premature infant born at 24 weeks gestation....

Up Close Pics Of Warts

Hardened Skin Tag

Close-up of the head and upper trunk of the same infant as in Figure 1.224. Note die thick, dry, rigid, hardened, cracked skin with deep crevices. The division of the thickened grey- to yellow-colored skin into polygonal, triangular or diamond-shaped plaques by the deep reddish to purple fissures has been said to simulate the traditional costume of a harlequin. The skin has been likened to die bark of a tree, crocodile skin, or Moroccan leather. Figure 1.223. Another example of a...

Pictures Of Staph Scalded Skin Syndrome

Scalded Skin Syndrome Bullae

This infant who developed a mild scalded skin syndrome toxic epidermal necrolysis Ritter's disease at the age of seven days had Staphylococcus aureus sepsis methi-cillin-sensitive . Note the large bul-lae at this very early stage of the staphylococcal scalded skin syndrome. This is rapidly progressive. The skin is erythematous with vesicular and bullous formation, and there is widespread wrinkling and loosening of the epidermis, which results in the scalded skin appearance. Figure...

Vernix During Pregnancy

Skin Tag Removal Home Remedy

Vernix caseosa in a female infant. After birth the infant is bathed and the vernix removed by the nurse. If there is any question as to whether or not there was any meconium staining, certain areas such as the axilla, inguinal folds and genitalia, if not adequately cleaned, will reveal traces of the vernix. Figure 1.8. Vernix caseosa in a female infant. After birth the infant is bathed and the vernix removed by the nurse. If there is any question as to whether or not there was any...

Langerhan Cell Histiocytosis Face

Langerhans Cell Histiocytosis Babies

The diagnosis of a hamartoma of hair follicle origin was established by biopsy of die midline lesions of die nose in diis infant. Figure 1.245. Congenital self-healing reticulohis-tiocytosis Hashimoto-Pritzker disease is a rare disease usually present at birth or within the first few days of life. It is characterized by solitary or multiple reddish-brown, pink, or purplish papulovesicu-lar lesions mainly on the scalp, face, trunk, and extremities. They tend to break down in the...

Blueberry Muffin Babies

Jaundice Infant

Another infant with cytomegalovirus infection showing the typical blueberry muffin appearance and jaundice soon after birth. Note that the head size is normal. Since most infections are asymptomatic, early diagnosis is only made in the full-blown syndrome manifested by the appearance of jaundice within the first 24 hours of life, hepatosplenomegaly, abdominal distention, anemia, thrombo-cytopenia, respiratory distress and neurologic changes. Figure 2.93. Another infant with...

Higoumenakis Sign Clavicle

Higoumenakis Sign Clavicle

Wimberger's sign in an infant with congenital syphilis is recognized by radiolucency due to erosion of the medial aspect of the proximal tibial metaphysis. Painless effusion in one or both knees Clutton's joints generally becomes apparent between 8 to 15 years of age, involutes spontaneously and leaves no residual effects. Figure 2.87. Wimberger's sign in an infant with congenital syphilis is recognized by radiolucency due to erosion of the medial aspect of the proximal tibial...

Rhagades Syphilis

Congenital Syphilis Baby Skin

Circinate lesions and syphilitic pemphigus of the soles present at birth in the same infant as in Figure 2.68. Figure 2.69. Circinate lesions and syphilitic pemphigus of the soles present at birth in the same infant as in Figure 2.68. Figure 2.70. Marked hepatosplenomegaly in an infant with congenital syphilis. Hepatomegaly occurs in 50 to 60 of affected infants. It is frequently associated with jaundice, anemia, splenomegaly and ascites. In the spectrum of congenital syphilis...

Desquamation Ichthyosis

Epidermolytic Hyperkeratosis

Another infant with a milder form of lamellar ichthyosis in which the parchment-like appearance of the skin is not as generalized. The skin develops widespread scaliness which may result in a generalized scaly erythroderma. If scaling and erythroderma are extensive, diere may be excessive fluid loss resulting in hypernatremia, dehydration, and temperature instability. These infants are also more susceptible to infection. Figure 1.218. Close-up of the face of the same infant as in...

Cutis Marmorata Telangiectatica Congenita

Cutis Marmorata Telangiectasia Congenita

In cutis marmorata telangiectatica congenita congenital generalized lymphangiectasia , dilated superficial venous and capillary channels are usually noted at birth. The skin appears as a reticulated network with white insulae in between. The classic appearance of reddish-blue reticulation of the skin changes with crying becomes increasingly red or other stimulation becomes livid with cooling . Most cases are generalized, such as in this infant, but there may be segmental or...

Listeriosis Disease

Pictures Listeriosis Infection

Haemophilus influenzae cellulitis of die prepatellar area in a neonate. Note the violaceous discoloration. This is very typical of Haemophilus influen-zae cellulitis. The infant may be very ill with diis type of infection. Cellulitis can occur as a result of infection widi many other organisms. Figure 2.42. In this infant with congenital listeriosis, skin lesions were present over the entire body at birth. These increased in number. The infant had severe respiratory distress and...

Protozoal And Parasitic Infections

Skull Calcification

Anteroposterior AP skull radiograph in a child with congenital toxoplasmosis. Note the diffuse areas of intracranial calcification. This is characteristic of toxoplasmosis and may be associated subsequently with hydrocephalus or microcephaly. Toxoplasma gondii infection is transmitted to the fetus by invasion of the bloodstream during the stage of maternal parasitemia, and may result in a wide spectrum of clinical signs and symptoms. The fetus may be stillborn, born prematurely,...

Cause Of Rubella Disease

Fetal Malformations Caused Rubella

Opisthotonos in an infant with congenital rubella encephalitis. Viral culture from cerebrospinal fluid was positive. Figure 2.127. Corneal clouding and prominence of left eye due to glaucoma in an infant with congenital rubella. One should suspect glaucoma buphthalmos in any infant with a wide or cloudy cornea. Figure 2.128. Opisthotonos in an infant with congenital rubella encephalitis. Viral culture from cerebrospinal fluid was positive. Figure 2.129. Adenopathy in an infant...

Epidermolysis Bullosa Newborn

Epidermolysis Bullosa Newborn

Epidermolysis bullosa is an autosomally inherited blistering and bullous disorder which is present at birth or becomes manifest soon after birth. It commonly affects die face, hands, feet, and variably the limbs and trunk and is characterized by trauma-inflicted erosions Nikolsky's sign and loss of the epidermis. As in this infant, the lesions are most commonly seen over the extensor surfaces and there are broken bullae with underlying erythroderma. Epidermolysis bullosa occurs in...

Super Numerary Nipple

Supernumerary Nipples

Note that the nipples are in the 5th intercostal space in this otherwise normal infant. The nipple may be found anywhere along the milk line which extends from the axilla to the pubis. Normally the nipple is located at the 4th intercostal space. Figure 1.81. Note that the nipples are in the 5th intercostal space in this otherwise normal infant. The nipple may be found anywhere along the milk line which extends from the axilla to the pubis. Normally the nipple is located at the 4th...

Diaper Dermatitis

Monilial Dermatitis

Typical candidal diaper dermatitis. Note the symmetric distribution of the rash with involvement of the intertriginous areas. Satellite lesions are often present. The skin is erythematous, swollen and slightly scaly. With healing, areas of depigmentation may occur. This should be differentiated from an ammoniacal diaper dermatitis where the rash is generally asymmetric, the intertriginous areas are spared, and satellite lesions are absent as it is a contact dermatitis. Figure...

Dermatographism

Dermatographism

This is a lesion of bullous mastocytosis urticaria pigmentosa that presented at birth in this infant as a solitary bullous lesion on the sole of the right foot. Note the area of redness surrounding the lesion dermatographism following examination of the lesion. Spontaneous remission of the skin lesions usually occurs. It is rare for lesions to appear after the age of 3 years. Differential diagnosis includes bullous impetigo, epidermolysis bullosa, incontinentia pigmenti, and...

Telangiectatic Nevi

Giant Melanocytic Nevus

A large garment nevus involving most of the trunk and perineum. In infants with a giant garment nevus there may be widely disseminated pigmented patches which represent satellite melanocytic nevi. In these infants there is a propensity for malignant change, and therefore an aggressive surgical approach is justified. Figure 1.174. This infant with a large garment bathing trunk nevus had skin breakdown with ulceration in utero and presented at birth with this appearance. Examination...

Hypoplastic Nails

Ichthyosiform 2016 Newborn

The feet of the same infant as in Figure 1.228 and 1.229 show the thick, rigid, hard, cracked skin and poorly developed toes with hypoplastic nails. Figure 1.231. The CHILD syndrome is an X-linked dominant disorder lethal to males which is characterized by congenital Kemidysplasia, with ichthyosiform erythroderma, and iimb defects. The hallmark of the disorder is the sharp mid-line demarcation and the ipsilateral involvement of the skin and the extremities. The face is spared, and...

Scabetic Lesion

Trichophyton Tonsurans Infection

CT scan of the same infant several days later with congenital toxoplasmosis. Note the rapid progress with massive loss of brain parenchyma and multiple scattered areas of calcification. Peripheral white blood count was remarkable for 96 eosinophils. There were numerous eosinophils in the cerebrospinal fluid. In toxoplasmosis, anemia, thrombocytopenia, and at times severe leukopenia may be present. The cerebrospinal fluid is xanthochromic, has an elevated protein level, and may...

Fetal Hydantoin Syndrome

Fetal Hydantoin Syndrome

This infant's triangular nails fit into the category of tapered nails that become progressively narrower and more hyperconvex as they grow distally. The nails generally reflect the size and shape of the underlying distal phalanx e.g., hypoplastic nail, narrow hyperconvex nail, short broad nail . Figure 1.100. In this infant with the fetal hydantoin syndrome the nails are hypoplastic and distorted or absent over the short hypoplas-tic distal phalanges. Note the digi-talization of...

Mastitis Neonatorum

Inclusion Cyst Newborn Nipple

Another example of mastitis neonatorum which is asymmetrical in that it is more prominent on the right than on the left. Mastitis neonatorum is noted more frequently in postmature infants. It subsides spontaneously over die course of several weeks. Figure 1.80. This infant has inclusion cysts of the right nipple. These require no treatment as they resolve spontaneously. Figure 1.79. Another example of mastitis neonatorum which is asymmetrical in that it is more prominent on the...

Athelia Disease

Athelia Disease

This infant with Poland's anomaly has absence of the nipple athelia on die right associated with die absence of die pectoralis muscle. Athelia is rare but is seen unilaterally in infants with Poland's anomaly, and bilaterally in certain forms of ectodermal dysplasia. Hypoplastic nipples are usually poorly pigmented with a narrow or absent areolar zone and little palpable breast tissue. Both sides are equally affected. Absence of the breast amastia is very rare. There is no sign of...

Newborn Nipples Are

Supernumerary Nipples Newborn

In this infant there is a unilateral supernumerary breast on the left side. Supernumerary breasts are rare. These are potentially functional and, like extra nipples, these structures occur along the embryonic milk line unilaterally or bilaterally, usually below the normal site of breast placement. The nipple and areola are quite well developed, distinguishing this anomaly from simple supernumerary nipples.

Umbilical Abscess

Funisitis Syphilis

Staphylococcal omphalitis and funisitis in a neonate. The erythema of the skin surrounding the umbilical cord is due to omphalitis. Funisitis represents infection of the umbilical cord per se. Note the redness of the umbilical cord. Figure 2.15. Nosocomial infection causing an abscess of the right wrist and cellulitis of the 4th finger in a premature infant birdi weight 1100 g at the age of 35 days. This infant had methicillin-resistant Staphybcoccus aureus bacteremia. There was no...

Bloch Sulzberger

Maculovesicular

Incontinentia pigmenti Bloch-Sulzberger syndrome is considered to be a neurocutaneous syndrome seen only in female infants X-linked dominant, generally lethal prenatally to the male . It has four cutaneous phases. In this infant note the early maculopapular appearance without vesicles or pigmentation. The lesions contain eosinophils, and blood eosinophilia is frequently present. In the next phase there are many vesicular lesions. These then become bullous and pustular. The bullae...

Tuberous Sclerosis Baby

Newborn Baby Hypopigmented Macule

A close-up of a typical ash leaf macule in tuberous sclerosis showing the characteristic hypopigmented leaf shape. In tuberous sclerosis, shagreen patches are also noted these are zones of slightly thickened and firm, yellow, irregularly outlined skin, a few centimeters across, with a finely dimpled surface resembling the skin of an orange. They are usually found on the flanks and back. Figure 1.151. Ash leaf spots are found on the skin of the trunk, buttocks, and limbs in...

Abscess On Scalp

Risus Sardonicus

This infant with neonatal tetanus has the typical trismus giving rise to the risus sardonicus and tetanic spasm. Especially note the hands. Risus sardonicus is a grinning expression produced by spasm of the facial muscles. Figure 2.55. These gangrenous lesions associated widi bacteremia caused by Pseudomonas aeruginosa demonstrate how devastating this infection can be. Figure 2.56. The typical opisthotonic appearance in an infant with neonatal tetanus. Note the head retraction,...

Neurofibromatosis

Neurofibromatosis Caf Lait Images

In partial albinism poliosis circumscripta piebaldism there are hypopigmented areas of the scalp. Depigmented areas may also occur on the torso or the extremities with the exception of the back, hands, and feet. Decreased hair pigmentation poliosis is most often seen close to the anterior hairline either centrally or to one side of the midline. This condition piebaldism is seen in normal individuals and may follow an autosomal dominant inheritance. Figure 1.157. Mother and infant...

Congenital Syphilis Bulla

Impetigo Bullosa Neonatorum

Desquamation on the palms and soles with no rash or desquamation elsewhere is very suggestive of congenital syphilis. The palms and soles may be fissured and erythematous and, as a result of subcutaneous edema, may have a shiny appearance. Figure 2.61. Note the desquamation of the palms and soles in a neonate. There were no other dermatologie lesions elsewhere. The VDRL Venereal Disease Research Laboratory test showed maternal blood to be reactive with a titer of 1 32 and the...

Celery Stalk Appearance

Celery Stalk Lesions And Rubella

Radiograph composite that demonstrates the types of bony changes found in congenital rubella syndrome from left to right, A celery stalk appearance B nonspecific growth arrest lines C a bony spicule at the medial condyle of the femur an uncommon finding . All of these regress over the first few months postnatally. Figure 2.135. Radiograph composite that demonstrates the types of bony changes found in congenital rubella syndrome from left to right, A celery stalk appearance B...

Transient Bullous Dermolysis Of The Newborn

Junctional Epidermolysis Bullosa

Epidermolysis bullosa in which the lesions were present at birth. The feet are one of the most commonly affected sites because babies kick their feet. If the lesions are extensive, the infant is at risk for fluid and electrolyte loss as well as infection. Figure 1.213. Epidermolysis bullosa letalis junctional epidermolysis bullosa, Herlitz's disease in an infant with generalized involvement of the skin. Note the massive involvement of the lower extremities showing the denudation,...

Impetigo Neonatorum

Impetigo Infant

Staphylococcal pyoderma of the neck in an infant at the age of 8 days. Figure 2.3. Bullous impetigo pemphigus neonatorum in a newborn infant at the age of 6 days. This infection may occur as early as the second day or as late as two weeks of life and may demonstrate bodi bullous and impetiginous lesions. It is most commonly due to a staphylococcal infection but, on occasion, is caused by Streptococcus. The lesions are more common in moist, warm areas such as the axillary folds of...

Cafe Au Lait Spots In Infants

Cafe Lait Spots Infants

Another infant with neurofibromatosis. The presence of a single cafe-au-lait spot in the axilla may be diagnostic of this disorder. Crowe's sign axillary freckling appears as multiple 1- to 4-mm cafe-au-lait spots in the axillary vault and is seen in 25 to 50 of patients with neurofibromatosis. Figure 1.163. Another infant with neurofibromatosis. The presence of a single cafe-au-lait spot in the axilla may be diagnostic of this disorder. Crowe's sign axillary freckling appears as...

Desquamation Of Skin

Desquamation Skin Newborn

The hand of die same infant as in Figure 1.1. showing die desquamation of the skin, long finger nails, and meconium staining. Figure 1.12. Marked desquamation of the skin in a post-term infant. This is a benign physiologic desquamation widi paper-thin peeling the underlying skin is normal. It occurs with postmaturity as the vernix disappears and the skin of the fetus is not protected from the amniotic fluid. The process is more marked in areas of irritation. Figure 1.11. The hand...

Erythema Toxicum

Erythema Toxicum

Cutis marmorata is a common finding in normal infants. This fine reticulated mottled appearance is due to vasomotor instability and thus is more commonly seen in premature infants, but should also alert one to the possibility of sepsis, hypothyroidism, and central nervous system pathology. Figure 1.19. Mongolian spots in a black infant. The spots have no significance but are sometimes suspicion of child abuse. This should be kept in mind when intentional injury is questioned. They...