quality education for a healthier scotland multidisciplinary examination of the skin promoting...

Quality Education for a Healthier Scotland

Multidisciplinary

Examination of the Skin

Promoting multiprofessional education and development in Scottish maternity care

Quality Education for a Healthier Scotland

Multidisciplinary

Content • Examination of the Skin• Colour• Rashes• Naevi• Infections• Miscellaneous.

Quality Education for a Healthier Scotland

Multidisciplinary

Examination of the Skin

• Easily visible including parents• Need to inspect entire body• Undress the baby• Integrate with systems examination.

Quality Education for a Healthier Scotland

MultidisciplinaryExamination of the Skin

• Trauma• Infection • Developmental abnormalities• Congenital conditions• Endocrine and metabolic• Retention of secretions.

Quality Education for a Healthier Scotland

Multidisciplinary

Examination of the Skin• Huge number of abnormalities seen!!!• If in doubt … ask someone more

experienced• Atlas of dermatology or

www.dermatlas.org• Dermatologist.

Quality Education for a Healthier Scotland

Multidisciplinary

Examination of the Skin

• IMPORTANT … Examination of the skin may reveal clues to a more general problem.

• For example … A blue baby or a white baby.

Quality Education for a Healthier Scotland

Multidisciplinary

Content

• Examination of the Skin• Colour• Rashes• Naevi• Infections• Miscellaneous.

Quality Education for a Healthier Scotland

Multidisciplinary

Colour• Jaundice • Pallor• Plethora• Cyanosis central, peripheral or

acrocyanosis• Bruising• Harlequin• Mottling cutis marmorata.

Quality Education for a Healthier Scotland

Multidisciplinary

Content

• Examination of the skin• Colour• Rashes• Naevi• Infections• Miscellaneous.

Quality Education for a Healthier Scotland

MultidisciplinaryRashes

Milia White papules are hyperplasticsebaceous glands, the effect of the transplacental hormones.They disappear with desquamation.

Quality Education for a Healthier Scotland

MultidisciplinaryRashes

Erythema neonatorum

•Is a maculo-papular rash which occurs in 30-70 % of normal term neonates.•It is very rare in the pre-term. •The rash fades by the end of the first week and no treatment is required.

Quality Education for a Healthier Scotland

Multidisciplinary

Content

• Examination of the skin• Colour• Rashes• Naevi• Infections• Miscellaneous.

Quality Education for a Healthier Scotland

MultidisciplinaryNaevi

Stork Mark is the light colour capillary dilatation commonly seen at the back of neck.  It may appear along the midline of the face.  Gradually fades within the first two years.

Quality Education for a Healthier Scotland

Multidisciplinary

Naevi

Capillary haemangioma (Port Wine Stain) 

Present at birth, flat or slightly raised.  Caused by dilated, mature capillaries in the superficial dermis.These do not regress. 

Quality Education for a Healthier Scotland

MultidisciplinaryNaevi

Port Wine Stain Treatment:

Until recently only cosmetic cover could be offered but good results are now being achieved with the pulsed dye laser.

Quality Education for a Healthier Scotland

Multidisciplinary

Strawberry Naevus

It is a cluster of dilated capillaries which appears within the first month after birth.  Raised and bright red, with discrete edges, occurring in any part ofof the body.  Usually regresses after one year of age.

Quality Education for a Healthier Scotland

MultidisciplinaryNaevi

Mixed HaemangiomaThere is a deep vascular

component here.Because the vision in the R

eye is under threat this will require treatment.

More unusual presentation the lesion on the heal began spontaneously involute after about 6 months of age.

Quality Education for a Healthier Scotland

Multidisciplinary

Naevi

Mongolian blue spotsblue-grey pigmentations often over the lower back and buttocks owing to an accumulation of melanocytes.  Very common in infants of races with pigmented skin.They become less obvious as the skin darkens.

Quality Education for a Healthier Scotland

Multidisciplinary

Giant Melanocytic Naevus

Large area of pigmentation often becoming hairy later.Long-term concern about malignant change though rare.

Quality Education for a Healthier Scotland

Multidisciplinary

CAFE AU LAIT

Quality Education for a Healthier Scotland

Multidisciplinary

Content

• Examination of the Skin• Colour• Rashes• Naevi• Infections• Miscellaneous.

Quality Education for a Healthier Scotland

Multidisciplinary

Infection

Skin Sepsis may suggest systemic infection requiringfull septic screen and vigorous use of antibiotics.

Quality Education for a Healthier Scotland

Multidisciplinary

Miscellaneous Skin Conditions

Petechial rash

Fairly common and not usually significant if only a few lesions and baby is otherwise well.

Quality Education for a Healthier Scotland

Multidisciplinary

Miscellaneous Skin Conditions

Vernix caseosumFoetal product of sebaceous glands, shed cells and hair.In most full-term babies at the time of birth.It dries and flakes off within a few hours.Not seen in post-term babies.

Quality Education for a Healthier Scotland

Multidisciplinary

Miscellaneous Skin Conditions

Accessory NippleNot uncommon, and the number may vary.Refer for removal

Quality Education for a Healthier Scotland

Multidisciplinary

Miscellaneous Rare Conditions

• Incontinentia pigmenti• Blistering disorders … epidermolysis

bullosa• Hypopigmentation … Albinism, ash leaf

patches• Hyperpigmentation … Café-au-lait spots• Icthyosis.

Quality Education for a Healthier Scotland

Multidisciplinary

Miscellaneous Rare Conditions

Incontinentia pigmenti

• X-linked, dominantly inherited disorder often associated with other abnormalities.

Quality Education for a Healthier Scotland

Multidisciplinary

Miscellaneous Rare Conditions

Epidermolysis bullosa

An inherited blistering disorder.

Quality Education for a Healthier Scotland

MultidisciplinaryIcthyosis.

Quality Education for a Healthier Scotland

Multidisciplinary

Any Questions?

Quality Education for a Healthier Scotland

Multidisciplinary

Examination of the Skin Summary

• Undress your baby fully.• Parents want to know what is

temporary and what is likely to be permanent.

• Remember associations with other conditions.

• ASK someone more experienced if you don’t know.