Faculty: Jonathan Dyer, MD
Dr. Dyer’s afternoon lecture reviewed a variety of skin findings in young children focusing on neonates. He discussed the importance of the vernix caseosa in the newborn. The vernix is an oil rich layer that coats the skin and is covered in natural antibiotics, therefore, he recommends the vernix be allowed to shed on its own. Dr. Dyer reports “there is no need to bathe a baby immediately after birth”. When bathing does proceed in the newborn, he recommends using warm water, patting the skin dry and using a bland gentle emollient. Dr. Dyer stressed “avoiding unnecessary exposure to allergens and irritants” in the newborn. The surface area to volume ration is much greater, therefore infants are at much greater risk for absorption.
The vernix is an oil rich layer that coats the skin and is covered in natural antibiotics, therefore, Dr. Dyer recommends the vernix be allowed to shed on its own.
Next Dr. Dyer illustrated the various presentations of miliaria in the newborn. Miliaria rubra is associated with excessive warming inside an incubator, overswaddling, fever and occlusive dressings. Ointments will worsen this condition, therefore creams are a better option for these patients. Seborrheic dermatitis presents as “cradle cap” as well as moist erythema in the flexural folds. In his experience, Dr. Dyer reports seborrheic dermatitis predicts atopic dermatitis in these patients. Therefore, it is even more important to use gentle skin care in these individuals. He recommends oil to help soften the scales on the scalp as well as weak keratolytics.
Miliaria rubra is associated with excessive warming inside an incubator, overswaddling, fever and occlusive dressings.
Neonatal acne was next discussed by Dr. Dyer. He reports this can present as inflammatory and even cystic acne. He will treat these more severe presentations with topical retinoids and benzoyl peroxide with adjustments to dosage based on age. These patients are likely at an increased risk for severe acne at puberty. Additionally, Dr. Dyer discussed dermoid cysts. The most common presentation is a mobile subcutaneous nodule on the lateral brow. A midline presentation of dermoid cyst is rare and warrants imaging due to high incidence of CNS communication. Further topics Dr. Dyer presented included aplasia cutis congenita, encephalocele and congenital syphilis.