Lesional Morphology and Assessment

Albert C. Yan, Ho Jin Kim, Paul J. Honig

Introduction

Newborn infant skin can manifest with an extraordinary array of conditions. Neonatal cutaneous findings may indicate transitory, benign processes such as erythema toxicum neonatorum, or may represent important harbingers of internal disease or genetic alteration, as might be observed in patients with herpes simplex virus infection or incontinentia pigmenti. Dermatologic manifestations are readily visible to the clinician, and it is often more efficient to first assess lesional morphology and then focus history-taking on the basis of the observed clinical findings. The timely identification and accurate diagnosis of skin findings in the newborn infant therefore relies on combining a comprehensive history with a meticulous physical examination, as well as on a proper understanding of physiologic differences between neonatal, pediatric, and adult skin that will influence both the diagnosis and the management of skin conditions appropriate to the neonate. This chapter reviews the principles of morphologic assessment in the term and preterm infant.

Reaction patterns

An understanding of the specialized reaction patterns is outlined in Tables 3.1–3.3 and Box 3.1 and, in conjunction with a comprehensive history and assessment of cutaneous morphology, will aid the clinician in making the proper dermatologic diagnosis.

TABLE 3.1

Primary lesions