18 - Skin, Hair, and Nails - Special Populations

Considerations for newborn skin exam

- smooth and soft, thinner than adolescents and adults

- amount of melanin in newborns varies

- more vulnerable to hypothermia (poorly developed subcutaneous fat layer)

- Curtis Marmorata

- lanugo

- vernix caseosa

Curtis Marmorata

lattice-like, bluish mottled appearance due to vasomotor changes in the dermis and subcutaneous tissue

Lanugo

fine, downy hair growth over body seen at birth

Vernix Caseosa

white, cheesy material composed of sebum and desquamated epithelial cells covers body at birth

Mongolian Spots (circumscribed dermal melanocytosis)

dark or bluish pigmentation over the buttocks and lower lumbar regions, usually becomes less noticeable and disappears with age

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What populations are Mongolian Spots most commonly seen in?

- African American

- Native American

- Asian American

- Hispanic

Less common in Caucasian infants

Cafe-au-lait spots

pigmented light-brown lesions 1-2cm in size

Isolated lesions have no significance

Multiple lesions suggest neurofibromatosis

Jaundice

Physiologic jaundice occurs during days 2-5 of life, progresses from head to toe, and breastfeeding is a common cause

Milia

- pinhead-sized smooth white raised areas without erythema caused by retention of sebum in sebaceous glands

- present occasionally at birth or first few weeks of life, resolves over a few weeks

Cradle Cap (infantile seborrheic dermatitis)

crusting white/yellow oily scales on a baby's scalp or forehead, clears spontaneously in the first 6-12 months

Impetigo

- honey-colored crusted lesions

- contagious, spread through contact

- skin infections usually caused by Strep or Staph

- usually around child or infants nose, mouth, hands, and legs

Molloscum

contagious viral skin infection caused by a poxvirus

How can skin change during pregnancy?

- Melasma or Cholasma "mask of pregnancy"

- Linea Nigra

- Pruritic urticarial papules and plaques of pregnancy (PUPPPs)

Melasma or Cholasma "mask of pregnancy"

Linea Nigra

Pruritic urticarial papules and plaques of pregnancy (PUPPPs)

How does skin change in an older adult?

- loses turgor and becomes lax

- increased hair growth over the tragus

- dermis is less vascular (paler/opaque skin)

Actinic Keratosis

precursor to squamous cell carcinoma

- superficial keratotic papules come and go on sun-damaged skin

- 1 in 1000 will progress to SCC (if untreated)

Seborrheic Keratosis

appear "stuck on", verrucous texture