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65 Cards in this Set
- Front
- Back
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Epidermis has ____ layers & what type of cells |
5 layers keratin-forming cells & melanocytes |
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Dermis has what type of tissue/glands |
Directly under epidermis -Fibrous tissue -Elastic tissue -Sweat glands -Sebacceous glands -Hair shafts |
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What is subcutaneous fat helpful with? |
Insulation Protection of internal organs Calorie storage |
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What is the stratum corneum? How many layers are there for nbn vs < 30 weeks vs 24 weeker |
top layer made up of dead cells. Constantly being replaced Newborn - 10-20 layers (same as adult) < 30 weeks - 2-3 layers 24 weeks - 0 layers |
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What is the relationship between the dermis & epidermis in an immature/premature infant? |
Cohesion between the dermis & epidermis are weak. The fibrils are more fragile and fewer apart (higher risk for abrasions/tears/adhesive injury as adhesives attach to DERMIS instead of epidermis) |
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MARSI stands for |
Medical adhesive related skin injury |
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When do sweat glands begin to function? Sweating on forehead? Check for ____ (2) |
-Adult function reached at 2-3 yo -Sweating is limited under 36 weeks -Ability increases with postnatal age Sweating on forehead? check for hyperthermia, CHD (increased sympathetic activity) |
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Lanugo |
downy hair, starts at 20-24 weeks, gone by 40 weeks |
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Lesion |
area of altered tissue |
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Macule |
discolored, flat spot < 1 cm in diameter that is not palpable |
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Patch |
macule > 1 cm in diameter |
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Papule |
elevated palpable lesion, solid & circumscribed. < 1 cm in diameter |
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Plaque |
Elevated, palpable lesion with circumscribed borders > 1 cm or a fusion of several papules |
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Vesicle |
elevation of the skin filled with serous fluid and < 1 cm in diameter "blister |
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Bulla |
Vesicle > 1 cm in diameter |
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Petechiae |
small, purplish hemorrhagic, pinpoint size spot does not blanch |
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Purpura |
small, hemorrhagic spot larger than petechiae, 1-3 cm in size does not blanch |
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Ecchymosis |
larger area of subepidermal hemorrhage does NOT blanch (mongolian spots do NOT blanch either) |
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Pustule |
Elevation of the skin filled with cloudy or purulent fluid |
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Cyst |
raised palpable lesion with fluid or semisoft filled sac (hallow/semisoft filled) |
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Nodule |
elevated palpable lesion with indistinct borders, can palpate below the skin |
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Crust |
Lesion of dried serous exudate, blood, or pus |
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Wheal |
collection of fluid in dermis that appears as a reddened, solid elevation |
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What diagnosis might you see with axillary freckling? |
Neurofibromatosis |
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Erythema neonatorum |
generalized hyperemia, first few hours after birth resolves in minutes to an hour (BRIGHT PINK) indicates successful completion of fetal to neonatal circulation |
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Harlequin color change is due to |
due to immature autonomic nervous system. (1/2 pale, 1/2 red) |
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Plethora - what do you check for? |
Check hct & for polycythemia (>65%) If polycythemic, ALSO check glucose (the ONLY fuel RBCs use) and for respiratory distress |
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Acrocyanosis |
Normal to persist up to 48 hrs of life exacerbated by low environmental temperatures Bluish hands/feet Important: Mucous membranes are PINK (can also look at scrotal tissue - should be bright pink) |
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circumoral cyanosis |
Blue around mouth More pronounced 1st 12-24 hrs -Often seen with feeds, resolves after eating -May be more normal in fair infants and is d/t blue color of veins below skin in this area |
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What causes the "blue" color in cyanosis? |
A desaturation of about 3-5 gm/dL Hgb for blue color to appear (~70% saturation) |
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Two infants have an O2 sat of 85%. Which one will turn blue first? Polycythemic baby or anemic infant? Why? |
Polycythemic baby will turn blue first because with all of that extra Hgb, a desaturation will be more apparent bc it will reach that 3-5 gm/dL quicker. (15% of 22g/dL = 3.3 of deoxy hgb vs 15% of 10 g/dL = 1.5 g/Dl of deoxy hgb) |
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What is jaundice? When is jaundice considered "pathologic"? |
Deposits of bile pigment in the skin due to hyperbilirubinemia; yellow skin & sclera Pathologic if seen in 1st 24 hrs General rule: first appears on face and progresses to toes as level rises |
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Jaundice d/t indirect/unconjugated hyperbilirubinemia appears what color? |
yellow |
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Jaundice d/t direct or conjugated hyperbilirubinemia appears what color? |
green/brown |
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What does phototherapy due to skin? |
It bleaches it! |
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Ichthyosis |
edematous hands, dry scaly skin that may be thick |
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Cutis marmorata: seen in response to; cause; what diagnoses are you thinking if it persists? |
Bluish mottling or marbling of skin Seen in response to: chilling, stress, overstimulation (Disappears when infant is warmed) Cause: constriction of small dilation of capillaries & vessels Persists: Trisomy 21/18 |
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Erythema toxicum: what is it; peak; duration; cause; presentations (2) |
benign rash, MC nbn rash, RARELY seen in preemies -peaks at 24-48 hrs (seldom seen after DOL 14) -Duration: few hours/days -Found ANYWHERE on body -Disappears & reappears -Cause unknown, resolve spontaneously -Presents in 2 ways: 1. urticaria neonatorum "fleabite dermatitis" - small white papules or vesicles with erythematous base 2. Vesicular lesions - pustules with NO inflammation |
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What is the definitive diagnosis to differential erythema toxicum vs herpes? What do you see? |
SCRAPINGS of a lesion can be done and fluid examined under microscope. Erythema toxicum shows eosinophils on gram stain Herpes shows positive direct fluorescent antibody test, positive Tzanck smear, multinucleated giant cells |
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Milia: what are they; where are they found; can they be seen elsewhere? |
Multiple yellow/pearly white papules about 1 mm in size -On brows, cheeks, nose -keratin-filled epithelial cysts -Resolves spontaneously -In mouth? Epstein pearls (palate) / Bohn's nodules (gums) |
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Sebaceous gland hyperplasia: what is it; cause; treatment |
Numerous tiny white or yellow papules found on nose, cheeks, and upper lips -Cause: maternal androgenic stimulation (testosterone) -Spontaneously decrease after birth, no tx *More YELLOW than milia |
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Milliaria: what it is; cause; where is it seen; how is it classified |
Heat rash -d/t obstruction of sweat ducts d/t excessively warm, humid environment -sweat glands are immature and easily obstructed -seen on forehead/scalp/skin folds -classified as 4 types (progressively gets worse - can take months to go away one pustular) |
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Classifications of milliaria |
Type 1 - "milliaria crystallina" clear, thin vesicles, 1-2 mm in diameter (no inflammation). usually head/chest. Usually appear later @ 2nd week Type 2 - "milliaria rubra" prolonged obstruction of ducts leads to release of sweat into adjacent tissue. Itchy, redness. Small, erythematous papules Type 3 - "milliaria pustulosa" progressive occlusion d/t leukocyte infiltration of papule (now it's bad!), may lead to secondary infection in deeper part of sweat gland Type 4 - "miliaria profunda" |
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Treatment of Milliaria? |
Eliminate source - eliminate extreme heat/ humidity Keep baby clean and dry |
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Hyperpigmented macule: common name; common placement; cause |
Mongolian spot Seen in 90% of AA/Asian/Hispanic infants Common - buttocks, flanks, shoulders Gray/blue green in color Doesn't change colors (bruises do!) Cause: melanocytes that infiltrate to the dermis Fade over 1st 3 years, some persist |
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Transient neonatal pustular melanosis: when does it star; how does it present; how do you test it / what do you see |
Superficial vesiculopustular lesions -Starts in utero, see flakes once born -Vesicles rupture in 12-48 hrs leaving small pigmented macules -macules surrounded by very fine white scales -seen most often in clusters under chin, neck, lower back, extremities -hyperpigmented macules usually regress in 1-2 months -On gram stain will see numerous neutrophils -Unknown etiology, benign, no treatment --> This baby comes out with pustules but otherwise healthy? No biggie! Probably TNPM |
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Pigmented nevus: what do they look like; most common sites; benign?
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dark brown/black macule -Commonly on lower back or buttocks -Generally benign - malignant changes can occur in up to 10% of infants -Watch for changes in size/shape -10% hairy pigmented nevi become malignant melanomas |
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Hairy pigmented nevus |
Pigmentation increases in 1st year -Plastic surgery by 5 years -Risk of cancer as an adult |
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What diagnosis are you thinking with multiple pigmented nevi? |
10-15% are malignant Neurocutaneous melanosis sequence - can be a/c seizures and mental deterioration |
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Junctional nevus |
flat, superficial excessive melanocytes at dermal - epidermal junction usually benign when present at birth |
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Sebaceous nevus |
rare, very few malignant NO hair follicles Leave alone or remove (cosmetic) Become larger during puberty dt sensitivity to androgens and become more wart like |
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Epidermal nevus |
Proliferations of the epidermis and papillary dermis -Usually unilateral, following Blaschko lines in linear configurations on limbs --> may have associations with CNS, bone, eye abnormalities in those with extensive lesions |
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Cafe au lait patches |
Tan/light brown macules or patches with well defined borders -When < 3 cm in length and < 6 in number, no pathologic significant -Larger / > 6 spots may indicate neurofibromatosis (90%) |
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What do you forcep marks look like? What else might you assess with a known forcep delivery? |
Red/bruised area where forceps were applied -Assess for complications such as facial palsy, fractured clavicles, or skull fractures |
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Subcutaneous fat necrosis: what is it; causes; when does it appear; what major side effect may occur that you need to monitor |
Subcutaneous nodule - hard, non pitting, sharply circumscribed -cause: trauma, cold, asphyxia -appears during 1st week of life, grows larger over several days then resolves over several weeks -Hypercalcemia may occur - more likely if more than one lesion (check iCa level) |
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Sucking blisters |
vesicles or bullae on lips, fingers, hands -d/t vigorous sucking in utero -intact or ruptured - no treatment |
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Nevus simplex |
"Stork bite" -MC birthmark -Irregular bordered pink macule composed of dilated, distended capillaries -Found at nape of neck/forehead/eyelids/bridge of nose or upper lip -BLANCHES with pressure -more prominent when crying -fades by 2 yo (may persist on neck) |
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Nevus flammeus |
"Port wine nevus" Flat pink or reddish purple lesion consisting of dilated, congested capillaries directly below the epidermis -Sharply delineated edges and does not blanch with pressure -Does not grow in size or spontaneously resolve GROWS WITH YOU, doesn't go away -May be small or cover 1/2 body -usually unilateral but may cross midline -most often on face, can be anywhere -laser therapy to eliminate/reduce |
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Sturger Weber syndrome |
Port wine stain that involves trigeminal nerve (over 3 areas of CN 5) -see seizures |
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Strawberry hemangioma: what is it; cause; where are they present; complications |
bright red, raised, lobulated tumor that occurs on head, trunk, or extremities -Soft and compressible with sharply demarcated margins -"little white halo" -10% nbns (later in preemies) -D/t dilated capillaries with endothelial proliferation in the dermal and subdermal layers -Present at birth - 6 months -May have internally -Gradually increase in size for 6 mo, then regress -Complications: bleeding, ulceration, infection, compression of underlying organs |
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Cavernous hemangioma: what is it; treatment; associated with what 2 syndromes |
Similar to strawberry but larger, more mature vascular elements lined with endothelial cells & involves the dermis and subq tissue -Skin is bluish red in color -Soft, compressible with poorly defined borders -Increase in sizes during 1st 6-12 months; disappears spontaneously -No tx unless interfering with vital fx -Tx with systemic corticosteroids -May be a/c with 2 syndromes: 1. Kasabach-Merritt (check platelets - they sequester in hemangiomas) 2. Klippel-Treaunay-Weber - underlying hypertrophy of tissue |
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Tuberous sclerosis - what do you see |
white leaf macules - unusual in nbn period |
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Blueberry muffin spots |
Extramedullary hematopoiesis - blood formed outside of the medulla of the bone Seen with rubella or CMV |
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Incontinentia pigmenti |
Lesions follow blaschko lines 4 stages of skin lesions: -vesicular -verrucous -hyperpigmented -atrophic/hypopigmented X-linked dominant |
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Epidermolysis bullosa |
CONSTANT pain group of rare diseases that cause the skin to blister |
