Hi, I'm Dr. Mollie Oudenhoven, and today I'm going to talk with you about newborn skin conditions that present within the first few days of life. Newborn rashes are very common, and while usually harmless, they can be a great source of parental concern. Over the course of the next four videos, we will discuss the most common rashes and lesions. Meaning areas of the skin affected by disease with an assortment of sizes, shapes, and colors that occur in the first month of life. In addition, I will address a few must not miss diagnosis. The first video, we'll discuss rashes and lesions commonly discovered during the first newborn exam. Next, I will discuss other rashes that present within the first month of life. And finally, I will discuss other lesions within the first month of life. Skin conditions can be a great source of uneasiness for both parents and providers. This module will help give you the skills needed to manage new skin. You may have wondered why babies sometimes are hairy when they are born. Well ,the reason is actually pretty interesting, the medical name for that fine soft hair on newborns is lanugo. When the baby is in the womb, they are covered in a thick, greasy substance called vernix, to help protect their skin from the acidic fluid in the womb. Lanugo helps the vernix stick to the body, as the baby gets closer to being at term, they need less and less vernix as their skin matures, so they lose that lanugo. For that reason, lanugo is most commonly seen in preterm infants. If present at birth, you can tell parents it'll typically go away after two to four weeks. Another common skin process that has to do with transitioning from the womb, is skin peeling. It is very common for newborn skin to peel, the baby just came out of a warm, moist environment into the harsh, dry air. Typically, the more vernix the baby has, that greasy substance the covers them in the womb, the less peeling they'll have because it helps moisturize their skin. Infants born after 40 weeks are more likely to peel since they lose vernix as they grow. Peeling self-resolves after the first week of life, reducing the duration of bathing and applying moisturizer will help the peeling be less severe. It's important to note that red cracked skin is not typical of newborn peeling. And such effect to the newborns should be evaluated by a dermatologist to determine whether they have a more serious form of dry skin, called ichthyosis. Which is the genetic condition that causes very, very severe dry, cracked skin. As we discussed, it can be a harsh transition from the warm, wet womb into the world. Mottling is another skin finding that demonstrates how newborns are trying to adjust to their new surroundings. The technical name for mottling is cutis marmorata. It's a reticular, meaning lace-like or net-like pattern of red-purple color change on the skin. It typically occurs in an even distribution over the extremities and torso. It's caused by areas of blood vessel narrowing followed by blood vessel widening, that occurs when the newborn gets cold. It resolves when the baby is warmed and no further intervention is needed. Newborns outgrow mottling as their circulatory system matures. If the mottling is uneven on each side of the body or does not resolve with warming, the newborn should also be evaluated by a dermatologist, as this may suggest a different underlying process. You might have seen these spots on adults before, but they are actually more common in newborns. Milia are tiny, firm, pearly-white papules filled with keratin, which is a skin protein. They are typically present on the face. We call them papules because you can feel a raised bump when run your hands over them. A newborn may have a few of them, or multiple clustered together. They are benign, meaning harmless, asymptomatic, and don't require any treatment. They will go away on their own over the course of weeks, but can take up to one to two months. This next skin finding, called sebaceous hyperplasia, is frequently confused for milia. Let's break down this word. Sebaceous refers to the oil fatty substance called sebum that is produced from sebaceous glands which are located in areas like the nose, cheeks, and chin. Hyperplasia means an increased number of glands. Many newborns are born with an increased number of these oily glands due to transmission of maternal hormones, mainly androgens. The sebum can have a yellowish appearance, thus newborns with sebaceous hyperplasia will have a collection of tiny yellow papules. First is the white papules seen with milia, and areas where sebaceous glands are present. The nose is the most common location that we see this newborn finding, and it tends to go away in the first few days of life. Congrats, you have now finished the first part of newborn skin conditions that present in the first few days of life. I know it's a lot of new information, so take time to synthesize what you have learned and move on to the next video whenever you are ready.
