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Figure 2.67. The raw hemorrhagic appearance of the lesions on the soles of the same infant as in Figure 2.66. In general, the more florid the manifestations of congenital syphilis at birth, the worse the prognosis. Figure 2.67. The raw hemorrhagic appearance of the lesions on the soles of the same infant as in Figure 2.66. In general, the more florid the manifestations of congenital syphilis at birth, the worse the prognosis. Figure 2.68. Characteristic circinate lesions involving the distal...
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Figure 1.115. 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...
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Figure 1.204. Nevus sebaceus of Jadassohn in the scalp. Note that this is a round, small lesion which could easily be missed on the initial physical examination. Linear epidermal nevi and verrucous nevi should not be confused with nevus sebaceus of Jadassohn which is a distinct and unrelated disorder. Figure 1.204. Nevus sebaceus of Jadassohn in the scalp. Note that this is a round, small lesion which could easily be missed on the initial physical examination. Linear epidermal nevi and...
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Figure 1.229. The hands of die same infant as in Figure 1.228. Note the pale, waxy, firm appearance and poorly developed digits which have become gangrenous. The nails may be hypoplastic or absent. Figure 1.229. The hands of die same infant as in Figure 1.228. Note the pale, waxy, firm appearance and poorly developed digits which have become gangrenous. The nails may be hypoplastic or absent.
Scaling Disorders
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...
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Figure 2.169. The same infant as in Figure 2.168 at the age of 11 days. Note die fungus on the omphalocele. KOH scrapings were positive for hyphae, and culture grew Aspergillus fumigatus. Aspergillosis is an uncommon opportunistic fungal disease. Aspergillus fumigatus is the most common, but the incidence of Aspergillus niger and other species is increasing. These fungi are ubiquitous and normally nonpathogenic. Primarily they affect debilitated individuals. Figure 2.169. The same infant as in...
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Figure 2.12. On the left note the normal physiologic engorgement of the breast. On the right there is a mastitis secondary to Escherichia coli infection. Although the most common cause of mastitis in the neonate is staphylococ-cal infection, other organisms may be responsible. Figure 2.12. On the left note the normal physiologic engorgement of the breast. On the right there is a mastitis secondary to Escherichia coli infection. Although the most common cause of mastitis in the neonate is...
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Figure 1.50. Edema and ecchymoses of the face in a premature infant who was delivered as a face presentation. These infants need to be checked for anemia and hyperbilirubinemia. Figure 1.49. Skin incisions over the buttocks in an infant following cesarean birth. Figure 1.50. Edema and ecchymoses of the face in a premature infant who was delivered as a face presentation. These infants need to be checked for anemia and hyperbilirubinemia.
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Figure 2.66. This infant with congenital syphilis had vesiculob-ullous hemorrhagic lesions which ruptured in utero and presented with the typical raw, hemorrhagic appearance of the palms and soles at birth. These lesions are highly infectious. Figure 2.66. This infant with congenital syphilis had vesiculob-ullous hemorrhagic lesions which ruptured in utero and presented with the typical raw, hemorrhagic appearance of the palms and soles at birth. These lesions are highly infectious.
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Figure 2.105. Herpetic lesions which appeared on the hand of an infant at the age of 5 days. The skin only was involved in this infant. There was rapid improvement on treatment with intravenous acyclovir. Infection may be acquired as the fetus passes through the birth canal. Thus, although skin lesions may be present at birth, the clinical picture of herpes in the newborn is frequently that of an apparently well infant who becomes symptomatic on the 4th to 8th day of life. The spectrum of...
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Figure 1.211. Note the bullae on the third and fourth toes and the extensive erosions after rupture of the bullae elsewhere on the foot of this infant with the dystrophic form of epidermolysis bullosa. In dystrophic epidermolysis bullosa, the blister forms in the papillary dermis below the basement membrane. These areas heal gradually, leaving atrophic scars, keloids, and contractures. Fingers and toes are bound together if there is loss of digits, and a mitten-like mass may form. Dystrophy of...
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Figure 1.243. The diagnosis of a nasal dermoid in this infant was confirmed by biopsy. Dermoids are usually present at birth and occur particularly along the lines of embryonic fusion. They are most common on the head, especially around the eyes and the nose. Dermoid cysts may be attached to underlying structures. In any midline nasal mass, intracranial extension is common thus, prior to removal of the mass, intracranial involvement should be excluded. Figure 1.244. The diagnosis of a hamartoma...
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Figure 2.98. Histopathologic section of lung demonstrating the typical owl's eye appearance of cells infected with cytomegalovirus. Postnatally acquired cytomegalovirus infection can occur in infants with primary immunodeficiencies or following transfusion with cytomegalovirus-positive blood, etc. Langston, C. Figure 2.98. Histopathologic section of lung demonstrating the typical owl's eye appearance of cells infected with cytomegalovirus. Postnatally acquired cytomegalovirus infection can...
Chapter 2 Perinatal Infection
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...
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Figure 2.74. Congenital syphilitic chorioretinitis of the right eye. Note the abnormal scarring in the macular area. Optic atrophy, if present, is usually seen in conjunction with neurosyphilis. These findings are extremely rare in congenital syphilis. Odier stigmata of congenital syphilis present much later. The deciduous teeth of children with early congenital syphilis are prone to caries but show no other abnormality. The stigmata of Hutchinson's triad Hutchinson's incisors, interstitial...
Other Dermatologic Problems
Figure 1.234. 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
Figure 2.30. 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...
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Figure 1.63. Dimples in between the joints over the long bones are considered pathologic until proven otherwise. In this infant with congenital hypophosphatasia, the skin dimple over the middle of the tibia is a very typical finding. Abnormal aberrant skin dimples may occur at a location where there has been a closer than usual proximity between die skin and the underlying bone structure during fetal life, resulting in deficient development of subcutaneous tissue at that locus. Such dimples may...
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Figure 2.37. 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.
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Figure 1.17. In this infant note the maculopapular rash which followed phototherapy treatment for hyperbilirubinemia. This bilirubin rash improves rapidly following discontinuation of phototherapy. Figure 1.17. In this infant note the maculopapular rash which followed phototherapy treatment for hyperbilirubinemia. This bilirubin rash improves rapidly following discontinuation of phototherapy. Figure 1.18. Mongolian spots in a caucasian infant. Mongolian spots are a minor anomaly commonly found...
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Figure 1.227. The hands and feet of the same harlequin fetus as in Figures 1.224, 1.225 and 1.226 show severe deformities which have occurred as a result of the tight constricting integument and compromise of the ectodermal structures, resulting in gangrene of the fingers and hypoplastic toes. The hands and feet are ischemic, hard, and waxy, often with poorly developed digits and an associated rigid and claw-like appearance of the limbs. The nails may be hypoplastic or absent. Figure 1.228....
Listeria Skin Newborn
Figure 2.43. 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...
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Figure 1.189. A close-up of die right lower extremity of an infant with incontinentia pigmenti. Note die presence of vesicles and the typical pattern of swirled hyperpigmentation of the skin that has been compared to that of a marble cake. This is present mainly on the extremities and trunk, and increases in intensity until the 2nd year of life. It may persist many years, then gradually fades. Figure 1.188. In a later phase of incontinentia pigmenti, between 6 to 12 months of age, red-brown,...
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Figure 1.61. A pigmented skin dimple over the left shoulder. Normal skin dimples in general tend to occur in areas where the skin is relatively tightly bound to the underlying bony prominences. Figure 1.62. Nonpigmented skin dimples in die iliosacral area. These tend to be crease-shaped and may be multiple over the lower part of the back. If midline, they should be distinguished from a pilonidal sinus. Figure 1.61. A pigmented skin dimple over the left shoulder. Normal skin dimples in general...
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Figure 2.83. Lower extremity radiograph showing characteristic erosions of syphilitic osteochondritis at the metaphyses of the distal ends of the long bones. About 15 of infants with osteochon-dritis will show signs at birth. Ninety percent will show radiologic evidence of osteochondritis and periostitis after the first month of life. In osteochondritis, there is increased widening of the epiphy-seal lines with increased density of the shafts, spotty areas of radi-olucency, and a resultant...
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Figure 1.127. The massive cavernous hemangioma involving the left leg and foot of this infant was compromised during in utero life, resulting in gangrene. The hemangioma was removed surgically after birth. In large cavernous hemangiomas the underlying structures may be involved, such as in this infant where the underlying osseous structures were involved. Figure 1.127. The massive cavernous hemangioma involving the left leg and foot of this infant was compromised during in utero life, resulting...
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Figure 2.123. The intrauterine growth retardation in congenital rubella may be very striking as shown in this term infant with a birthweight of 860 g. The lesions of congenital rubella may be few or numerous and generally occur on the head, trunk, or extremities. Many of the larger lesions tend to be raised. They usually disappear within 3 to 4 weeks the larger lesions more slowly than the small flat nodules . Figure 2.124. Although the infant with congenital rubella was of extremely low...
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Figure 2.165. Invasive asper-gillosis of the skin in a small premature infant birthweight 785 g at the age of 7 days. Note the involvement of the back and the right axilla. Infant was treated with amphotericin. Figure 2.163. Candidal arthritis of the right ankle in an infant who developed candidal sepsis while on prolonged total parenteral nutrition for short bowel syndrome. Figure 2.164. Candidal scalp infection in an infant on peripheral parenteral nutrition. The abscesses were recurrent...
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Figure 1.145. A large cavernous lymphangioma affecting the right gluteal region and proximal lower extremity of an infant. There was no osseous involvement. Figure 1.146. Cystic hygroma of the right side of the neck with involvement of the mucous membranes. Cystic hygroma is a benign loculated cystic mass which is soft, diffuse, impressible, and translucent due to accumulation of fluid in the lymphatics. The commonest sites are in the neck hygroma colli , axilla, and upper arm. Rarely they are...
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Figure 2.170. The same infant as in Figure 2.168 and 2.169 at the age of 18 days showing generalized involvement of the skin. The skin lesions are characterized by erydiematous papules which develop into hemorrhagic bullae and then become violaceous plaques with central necrosis. Figure 2.171. This small premature infant born at 23 weeks gestation birth-weight of 580 g had severe hyaline membrane disease and a large ductus arteriosus. She was referred at the age of 33 days, having developed a...
Newborn Has Skin Tags In Mouth
Figure 1.73. A baby with a tail. 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...
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Figure 2.81. Radiograph of the upper extremity of an infant with congenital syphilis showing growth arrest lines, periostitis, and fracture of the ulna. Periostitis is seldom visualized at birth because of lack of sufficient calcification at that time to cast a shadow. It is more commonly seen at 4 to 6 weeks of age and, at that time, must be distinguished from that seen in healing rickets, child abuse, and infantile cortical hyperostosis. As the bone is more fragile with syphilitic infection,...
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Figure 2.116. Parvovirus B19 infection resulting in intrauterine death in a hydropic stillbirth. Human parvovirus B19, the same virus that causes erythema infectiosum, has a special affinity for rapidly dividing cells, particularly erythroblasts therefore, an infection may result in profound anemia, hydrops fetalis, and death in the fetus. Singer, D. Figure 2.115. Gross pathologic specimen of the liver of the same infant as in Figure 2.114 showing herpetic lesions. The disseminated form of...
Pseudomonas Cellulitis
Figure 2.49. 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...
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Figure 2.92. 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
Figure 2.89. 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...
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Figure 2.120. Congenital rubella in a term infant with severe intrauterine growth retardation birthweight 1300 g . Note die blueberry muffin appearance. Infected infants are usually bom at term, but with low birthweight. In addition to the blueberry muffin lesions there may be thrombocytopenic purpura, hyperbilirubinemia, hepatosplenomegaly, pneumonia, congenital cardiac defects especially patent ductus arteriosus , eye disorders, deafness, and meningoencephalitis. Figure 2.120. Congenital...
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Figure 2.117. 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....
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Figure 1.2. Pigmentation of the areola of the nipple in a newborn infant. Pigmentation is more marked in black infants. Figure 1.2. Pigmentation of the areola of the nipple in a newborn infant. Pigmentation is more marked in black infants. Figure 1.3. Pigmentation at the base of the nails in a black infant. There may be little pigmentation of the skin in general at birth, but the finding of pigmentation at the base of the nails, pinnae of the ears, axilla, areolae of the nipples, genitalia, and...
Up Close Pics Of Warts
Figure 1.225. 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...
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Figure 2.111. Herpetic lesions present on the vulva following a breech presentation. Note also the presence of ecchymoses. Skin lesions occur most often on the scalp and face, the areas which are closest to and in longest contact with the cervical area from which infection is transmitted. Involvement of the cornea in vertex presentations and the genitalia in breech presentations is thus common in herpetic infection. Figure 2.111. Herpetic lesions present on the vulva following a breech...
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Figure 2.25. 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...
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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 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...
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Figure 1.111. Another example of a nevus anemicus present at birth on the left thigh. Capillary hemangiomas strawberry nevi may be present at birth, but generally develop during the first few postnatal weeks as pale or slightly reddened, well-demarcated zones of skin a few millimeters to several centimeters in diameter. They may occur on any area of the body but are seen most commonly on the head and neck 40 and the trunk 30 . During the first months of life, rapid growdi occurs and the lesions...
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Figure 1.244. 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...
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Figure 1.180. In about 5 of cases, mastocytosis is localized. In the figure on the left there is a solitary tan to brownish-colored, slightly raised lesion on the back. As seen in the figure on the right, rubbing the skin over this area results in dermatographism Darier's sign due to histamine release. Nodular forms of mastocytosis must be differentiated from xanthoma and juvenile xanthomagranulomas. Figure 1.180. In about 5 of cases, mastocytosis is localized. In the figure on the left there...
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Figure 2.93. 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...
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Figure 1.186. In this phase of incontinentia pigmenti, vesicles and bullae have formed and these have broken down with some increased pigmentation. Figure 1.187. A close-up of the right upper extremity showing the vesicles with some verrucous element and increasing pigmentation with a tendency to follow Blaschko's lines. Figure 1.187. A close-up of the right upper extremity showing the vesicles with some verrucous element and increasing pigmentation with a tendency to follow Blaschko's lines.
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Figure 1.242. Close-up of the exfoliative erythroderma in the same infant as in Figure 1.241. This infant died at the age of 10 weeks, and at autopsy was found to have a primary immunodeficiency syndrome. Cutaneous manifestations of acute GVHD disease must be distinguished from drug eruptions or viral exan-thems. Figure 1.242. Close-up of the exfoliative erythroderma in the same infant as in Figure 1.241. This infant died at the age of 10 weeks, and at autopsy was found to have a primary...
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Figure 2.27. In this infant with the staphylococcal scalded skin syndrome, the bullous lesions have ruptured, resulting in the scalded skin appearance. Staphylococcal scalded skin syndrome is also known as Ritter's disease. Figure 2.26. In the same infant there is rupture of the bullae. These infants present with the typical Nikolsky's sign in that there is skin exfoliation which peels on touch. Figure 2.27. In this infant with the staphylococcal scalded skin syndrome, the bullous lesions have...