Many dermatological conditions are present especially during childhood. The causes of these conditions range from infection to congenital inflammation. Many common rashes and birthmarks that occur in the pediatric population are benign and, although they may be important to recognize do not require any specific therapy. However, other conditions require a thorough evaluation and close follow-up to ensure the best possible outcome.
This article addresses several childhood dermatoses, including their diagnosis and treatment.
1. Infantile Hemangiomas
Infant hemangiomas are benign vascular neoplasms composed of the proliferation of thickened endothelial cells. They are the most common childhood tumors. Infant hemangioma occurs more often in girls than in boys and is more common in Caucasian infants. The major risk factor is low birth weight; However, premature birth, multiple pregnancies, advanced maternal age, placenta previa, preeclampsia, and placental abnormalities are also risk factors.
Although doctors can often diagnose hemangiomas based on the history and physical exam, advanced imaging tests can be helpful such as :
- X-rays and computerized tomography (CT) scans
- Magnetic resonance imaging (MRI) scans
- Blood tests
Without any specific intervention, most infant hemangiomas regress and the lesion shrinks from the center. About 50-60% resolve incompletely, causing permanent skin changes.
Complex hemangiomas, including large segmental hemangiomas, airway or pentobarbital hemangiomas, or those with extensive ulceration, should be treated with systemic propranolol. Tropical beta-blockers may be considered for uncomplicated superficial hemangiomas that may be of less cosmetic concern. Pulsed dye laser treatment, surgical excision, and embolization may be considered for hemangiomas that have refractory ulceration or that do not regress completely.
2. Nevus Sebaceous
A sebaceous nevus is an enclosed hematoma composed mainly of sebaceous glands. This dermatological condition affects 0.3% of newborns, with sporadic but equal frequency in males and females of all races.
The lesion is usually seen as a solitary, hairless patch on the scalp or a tan organic yellow velvety plaque in other areas. During adolescence, it can be warty and nodular with a round, oval, or linear shape.
The definitive treatment for a sebaceous nevus is full-thickness excision. However, because the risk of malignancy arising in a sebaceous nevus is estimated to be less than 1%, observation is usually chosen as excision.
3. Transient Neonatal Pustular Melanosis
Transient melanosis of neonatal pustules is a benign and idiopathic dermatological condition characterized by vesicles, superficial and pigmented pustules. The overall incidence is 2.2%, which is evenly split between the sexes, with rates of 0.6% in white children and 4.4% among black children.
At birth, the lesions usually appear on the chin, neck, forehead, chest, buttocks, and back, and less often on the soles of the hands and feet. The lesions are usually 2 to 10 mm in diameter and usually resolve within 48 hours. However, brown spots can persist for several months.
Treatment is not indicated, but the lesion should be differentiated from pustular and vehicular dermatitis that develops from infectious causes, especially congenital herpes simplex.
4. Erythema toxicum Neonatorum
Neonatal toxic erythema (ETN) is a benign, self-limiting and asymptomatic skin condition that affects 31–72% of newborns, with a similar incidence between genders and races. ETN usually presents within the first 4 days of life.
Characteristic lesions are erythematous macules and papules usually distributed over the trunk and proximal extremities. They progress to pustules on an erythematous basis. The condition usually resolves in 5-7 days, but it may come and go before it resolves.
Generally, the diagnosis can only be established by history and physical examination, although a Wright stain of pustular material specifically demonstrated eosinophils.
5. Neonatal Herpes Simplex Virus Infection
Neonatal herpes simplex is an infection caused by vertical transmission of the herpes virus from mother to child. Factors influencing transmission include mode of delivery,(cesarean versus vaginal) state of an outbreak during delivery (active versus non-active), type of infection (primary versus recurrent), maternal antibody status against HSV, fetal scalp Includes use and duration of electrodes, membrane rupture. Infection can occur during the asymptomatic shedding of the virus.
Neonatal HSV infection can be classified into three main categories: skin, eye, and mouth disease (SEM); Central nervous system (CNS) disease with or without SEM disease; and spread disease.
Definitive diagnosis of neonatal herpes infection requires the detection of herpes simplex viral DNA using viral culture or polymerase chain reaction assay. Treatment includes antiviral medication and often requires admission to the intensive care unit.