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Disorders of the Subcutaneous Tissue

Introduction The subcutaneous fat cushions the overlying skin, insulates and provides energy storage, and protects underlying soft tissue and bony structures. Although not fully functional at birth, a well-developed fatty layer is present in the neonate, even when premature. Disorders of the fat can interfere with normal function and may have systemic implications. The nomenclature and classification of subcutaneous fat disorders of the newborn are inconsistent…

Lumps, Bumps, and Hamartomas

Lumps and bumps A wide variety of conditions affecting the skin and subcutaneous tissues present as papulonodular lesions, or ‘lumps and bumps.’ Benign and malignant neoplasms, hamartomas, and inflammatory and infectious disorders, as well as a number of infiltrative diseases, can be included in this category. Some of these conditions are discussed in detail in other chapters. This section deals with a group of nonmalignant disorders…

Acneiform and Sweat Gland Disorders

Acneiform disorders Neonatal acne (neonatal cephalic pustulosis) Neonatal acne (acne neonatorum) is a very common newborn eruption, occurring in up to 20% of healthy babies. Lesions are not present at birth but typically appear within the first 2–3 weeks of life and generally improve by about 4 months of age. Small inflammatory red-pink papules and pustules predominate, occurring symmetrically on the cheeks ( Fig. 25.1 ).…

Disorders of Hyperpigmentation and Melanocytes

Introduction Hyperpigmented lesions, presenting at birth and during the first few weeks of life, are quite common. Pigmented lesions can range from small and isolated to large and multiple. They can exist independently, or in association with other signs and symptoms, and may lead to the diagnosis of a congenital or genetic skin disease. In some cases, hyperpigmented ‘birthmarks’ may not be evident at birth but…

Hypopigmentation Disorders

Introduction A diverse group of conditions present with hypopigmentation in neonates and infants. A practical clinical approach would be to categorize them according to the distribution of the hypopigmentation: generalized, mosaic, or localized ( Box 23.1 ). Some may be present at birth, but not noticed until later in infancy because neonates often have a lighter skin at birth than in later life. Box 23.1 Hypopigmentary…

Vascular Malformations

Introduction to vascular malformations In 1982, Mulliken and Glowacki proposed a biologic classification of vascular birthmarks that has become widely accepted. It was modified slightly in 1996 by the International Society for the Study of Vascular Anomalies (ISSVA). Two major groups of vascular birthmarks are recognized: vascular malformations, which are composed of dysplastic, malformed vessels; and vascular tumors, which demonstrate cellular hyperplasia. The distinction between malformations…

Infantile Hemangiomas and Other Vascular Tumors

Infantile hemangioma Infantile hemangioma (IH) is the most common vascular tumor encountered during early infancy. It is a benign proliferation of endothelial cells that characteristically undergoes a phase of rapid growth followed by slow spontaneous involution. Although large population-based studies are lacking, infantile hemangiomas are estimated to occur in 2.6–5% of infants. The incidence is highest among Caucasian infants with lower rates in African-American, Hispanic, and…

Immunologic, Reactive, and Purpuric Disorders

Introduction In this chapter, a number of non-related entities will be discussed. They appear grouped by convenience, and represent a heterogeneous group of genetic and acquired diseases with a common ground of an immunologic pathophysiology. Several disorders appear to represent hypersensitivity reactions. Purpuric eruptions will also be covered in this chapter. The differential diagnosis of purpura is extensive in neonates and young infants, and includes hematological…

Disorders of Cornification (Ichthyosis)

Introduction The term ‘inherited disorders of cornification’ covers a wide range of genetic conditions with molecular defects that preclude the formation of a normal epidermis. The term is usually considered to include entities divided on morphological grounds into ichthyoses, follicular keratoses, and palmoplantar keratodermas. In addition, many inherited disorders usually considered as ectodermal dysplasias have significant defects in epidermal development or differentiation. Several ichthyotic conditions first…

Erythrodermas, Immunodeficiency, and Metabolic Disorders

Erythrodermas The term ‘erythroderma’ is used in dermatology to describe a skin eruption characterized by diffuse erythema, usually in association with scaling. Infantile erythroderma is caused by or associated with a large number of disorders ( Box 18.1 ). The differential diagnosis includes inflammatory, infectious, inherited, and immunologic diseases, many of which have a hereditary basis. Some of these diseases are potentially life-threatening, and erythroderma itself…

Diaper Area Eruptions

Introduction Eruptions in the diaper region have diverse origins. This chapter will review eruptions, both common and uncommon, that have major findings in the diaper area not only in neonates but also in young infants ( Box 17.1 ). Many of the conditions listed in Chapter 10 (vesicles, pustules, bullae, erosions, and ulcerations) may be seen or arise in the diaper region. There are diseases that…

Papulosquamous and Lichenoid Disorders

Papulosquamous disorders Psoriasis Introduction Psoriasis is a chronic, inflammatory papulosquamous disease with an estimated prevalence of 1% in children. Pediatric psoriasis is subdivided into congenital, infantile, and childhood, defined as psoriasis presenting at birth, in the first year of life, and between ages 1 and 18 years, respectively. One-third of all patients develop psoriasis in the first two decades of life. Up to 30% of these…

Eczematous Disorders

Introduction Eczematous eruptions represent a significant proportion of the skin diseases affecting neonates and infants. Clinically they are characterized by erythema, edema, scale, and sometimes crusts. The most common disorder is atopic dermatitis (AD) and, in fact, the term ‘eczema’ (which means ‘boiling over’) is often used by laymen to refer to AD. Seborrheic dermatitis and irritant dermatitis also frequently affect infants, while allergic contact dermatitis…

Fungal Infections, Infestations, and Parasitic Infections in Neonates and Infants

Fungal infections Infections caused by fungi and yeasts are common in neonates and infants. Among the most frequent are Candida infections such as thrush and diaper dermatitis. More extensive manifestations, such as congenital and systemic candidiasis, are much less common. Improvements in preterm infant survival due to advances in neonatal intensive care and an increase in bone marrow and organ transplantation have resulted in more frequent…

Viral Infections

Introduction Viral infections can induce a remarkable variety of cutaneous manifestations in the neonate and toddler. The clinical manifestations of any viral infection are influenced by the virulence, tissue tropism, and age at which the infection is acquired. Infections may occur in utero, perinatally (acquired between the onset of labor and the delivery), or postnatally. Skin findings may be a result of local invasion and infection,…

Botulinum Toxin

Synonyms ▪ Botulinum toxin type A, botulinum A exotoxin, BoNT-A; onabotulinumtoxinA – BOTOX®/BOTOX Cosmetic®; abobotulinumtoxinA – Dysport®, Azzalure®; incobotulinumtoxinA – Xeomin®/Bocouture® ▪ Botulinum toxin type B, BoNT-B; rimabotulinumtoxinB – MYOBLOC® Key features ▪ Botulinum toxin (BoNT) causes chemodenervation of muscles by blocking acetylcholine release ▪ BoNT is also capable of inhibiting the release of other neurotransmitters, such as substance P, noradrenaline, calcitonin gene-related peptide, and glutamate…

Injectable Soft Tissue Augmentation

Key features ■ Fillers are used to soften the appearance of superficial wrinkles and to recontour and smooth the deep folds of the face ■ Other indications include reducing the appearance of atrophic, traumatic and acne scars; lip augmentation; and volumizing the face in areas of lipoatrophy or senescence-associated fat loss ■ Agents include hyaluronic acid derivatives, synthetic materials, and autologous fat ■ Selection of an…

Hair Restoration

Introduction Hair frames our face and its length, color and style reflect our personality and how we perceive ourselves. The framing preserves a youthful facial appearance by shortening the face and returning the viewer's focus to the center of the face. While hair is one of the few physical characteristics we can easily control, the inability to correct hair loss can lead to concerns regarding appearance…

Body Contouring: Liposuction and Non-invasive Modalities

Synonyms ■ Liposculpture ■ Tumescent liposuction ■ Lipoplasty ■ Lipolysis Key features ■ Liposuction is indicated for spot reduction of localized adiposities ■ Liposuction is ideally suited for healthy patients who are near their ideal body weight ■ The tumescent local anesthetic technique is the safest approach to anesthesia for liposuction ■ Compared to liposuction, non-invasive modalities offer the benefit of less downtime but often deliver…

Phlebology and Treatment of Leg Veins

Key features ■ Superficial telangiectasias, reticular veins, and varicose veins of the lower extremities are interconnected and develop after impairment of venous return ■ Poor venous return results from venous valvular incompetence or primary muscle pump failure ■ A pretreatment physical examination to assess the extent and cause of the venous abnormalities should be performed with the patient in a standing position ■ The physical examination…