26 HOW TO TREAT : BABY RASHES
26 HOW TO TREAT : BABY RASHES
1 SEPTEMBER 2023 ausdoc . com . au
Figure 11 . Café-au-lait macules .
Figure 12 . Giant congenital melanocytic naevus
PAGE 24 methylprednisolone aceponate 0.1 % w / w ointment once daily to Jack ’ s face , betamethasone dipropionate ( Diprosone ) 0.05 % w / w ointment once daily to the body and pimecrolimus 1 % w / w cream twice daily to the eyelids for any dry , itchy or flaky areas . Authority scripts are supplied .
Britney is reluctant to use steroids as she has heard from her friends that they can cause thinning of skin . Her GP provides her with information from the Australasian College of Dermatologists and counsels Britney regarding the safety and efficacy of topical steroid usage on affected areas . Britney is happy with the treatment options and Jack ’ s atopic dermatitis is well controlled with frequent emollient use and topical treatment when required .
How to Treat Quiz .
1 . Which THREE statements regarding eczema are correct ? a Eczema presents with erythematous , scaly plaques , sometimes with weeping or crusted lesions . b Emollients are an essential aspect of management . c Eczema may , rarely , be a presenting sign of immunodeficiency . d The goal of management is cure .
2 . Which TWO statements regarding baby rashes are correct ? a Nail changes of psoriasis are present in up to 90 % of infants . b Mild psoriasis may be controlled with emollients and topical corticosteroids as monotherapy or in combination with vitamin D analogues . c The presentation of scabies in infants includes a generalised vesiculopapular eruption with lesions typically found on the palms , soles , neck , axilla and head . d An inability to visualise scabies mites from skin scrapings microscopically rules out the diagnosis .
3 . Which THREE statements regarding baby rashes are correct ? a Infantile seborrhoeic dermatitis is usually asymptomatic and resolves without intervention over weeks to months . b Treatment of seborrhoeic dermatitis involves the application of topical steroid until the scale lifts . c Topical terbinafine 1 % cream is typically sufficient for tinea corporis , tinea faciei or tinea pedis . d Skin scrapings prepared with potassium hydroxide can confirm the diagnosis of tinea with direct visualisation of segmented hyphae under the microscope .
4 . Which TWO statements regarding baby rashes are correct ? a Ichthyoses are mild , selflimiting conditions . b Management for ichthyoses includes frequent bathing and emollients . c NLE is caused by maternally transmitted autoantibodies . d NLE is present at birth .
5 . Which THREE statements regarding blistering baby rashes are correct ? a Both neonatal acne and true infantile acne heal with permanent scarring . b Toxic erythema of the newborn is a benign , self-limiting condition that affects up to 70 % of newborns .
Case study two
Ashley , a 26-year-old woman of Caucasian heritage delivers a female neonate , Phoebe , at 36 weeks ’ gestation . Phoebe has a low birthweight and requires a three-day stay in the neonatal ICU . She is an otherwise healthy child with no abnormalities detected on newborn examination . Ashley presents to her GP when Phoebe is three weeks old concerned
GO ONLINE TO COMPLETE THE QUIZ ausdoc . com . au / how-to-treat
c Miliaria is commonly seen in hot and humid climates . d The hyperpigmentation of TNPM fades over weeks .
6 . Which TWO statements regarding neonatal blistering are correct ? a Most causes of blistering are benign and self-resolving . b Neonatal pemphigus and bullous pemphigoid are maternally transmitted autoimmune diseases . c Neonatal cephalic pustulosis is a bacterial condition requiring systemic antibiotics . d Viral , bacterial , fungal and parasitic infections may cause blistering .
7 . Which THREE statements are correct ? a IHs are typically present in the first few days of life and proliferate rapidly over the first six months of life . b Most IHs will require surgical management . c The growth of CMs are commensurate with the child . d A CM may be mistaken for naevus simplex , a common , benign vascular birthmark that is colloquially termed a ‘ salmon patch ’.
EARN CPD OR PDP POINTS
• Read this article and take the quiz via ausdoc . com . au / how-to-treat
• Each article has been allocated one hour by the RACGP and ACRRM .
• RACGP points are uploaded every six weeks and ACRRM points quarterly . about a red rash on Phoebe ’ s forehead . Phoebe is otherwise healthy and feeding well . On examination , the GP notes that the ‘ rash ’ consists of a red patch that blanches on compression . The GP suspects naevus simplex and advises Ashley to monitor the lesion and return if it worsens .
Over the span of two weeks , the lesion rapidly proliferates into a 15mm erythematous plaque that is warm on
BABY RASHES
8 . Which THREE may cause bruising in a baby ? a Hereditary haemorrhagic telangiectasia . b Abuse . c Vitamin C deficiency . d Marfan ’ s syndrome .
9 . Which TWO statements regarding skin colour change in a baby are correct ? a Bruises are rare in infants younger than six months because of their lack of mobility . b Physiological jaundice typically occurs within the first 24 hours of life . c Erythroderma is a potentially life-threatening clinical presentation characterised by diffuse erythema of the skin . d Cyanosis is characterised by the bluish discolouration of tissues when oxygenated haemoglobin exceeds 3g / dL .
10 . Which THREE statements regarding skin colour change in a baby are correct ? a Primary acrocyanosis is a benign , transient finding in healthy newborns . b Persistent central cyanosis is pathological in almost all cases . c Observe uncomplicated , small CMN as these lesions may develop a range of benign or malignant growths . d Café-au-lait macules always indicate neurofibromatosis . palpation ; this prompts referral to a paediatric dermatologist .
Ashley and her partner present to the dermatologist when Phoebe is six weeks old . After a thorough history and physical examination , the dermatologist diagnoses a superficial IH . Ashley is counselled on the proliferating and involuting course of the lesion . Treatment options are discussed , including topical timolol , oral propranolol and more invasive options including laser therapy and surgery . Ashley is hesitant to use systemic treatment and elects for topical timolol . Ashley notes that she has read up on PHACE syndrome ( see table 2 ), but the dermatologist reassures her that systemic involvement is unlikely given the focal distribution .
Phoebe is started on topical timolol maleate 0.5 % gel , up to two drops daily . Six weeks after starting treatment , the IH has begun to regress . Phoebe continues treatment until the age of one . At Phoebe ’ s first birthday she is meeting all her developmental milestones and the lesion has regressed significantly . By her fifth birthday the lesion has completely involuted without residual telangiectasia .
CONCLUSION
WHILE most neonatal rashes are benign , GPs play a critical role in the identification and referral of atypical presentations that may represent serious underlying disease . When the source of the rash is uncertain , refer patients to a paediatric dermatologist . In more severe cases , such as with a collodion baby or neonatal blistering , consider referral to a multidisciplinary team with a subspecialty paediatric service .
RESOURCES
• John S , Common rashes in neonates . Australian Family Physician 2012 41 ; 280-286 bit . ly / 3qvdBp1
• @ dr . deshan www . instagram . com / dr . deshan /
• DermNet New Zealand bit . ly / 43K0rTn
• Australasian College of Dermatologists — Position statements bit . ly / 3MMdQn4
References Available on request from howtotreat @ adg . com . au