Skin

Inspect for dermatologic conditions. Seborrheic dermatitis is the most common rash seen in the first month of life; it begins at 2 to 4 weeks of age and subsides after 3 to 4 months of age. An initial manifestation is often a crusting of the scalp known as cradle cap, as shown in Figure 24-26. The greasy, salmon-colored, nonpruritic, sharply delimited oval scales involve the scalp and face, especially the forehead, eyebrows, nasolabial folds, and retroauricular folds. Figure 24-27 shows seborrheic dermatitis in another patient. Notice the greasy papular eruption on the face of this 3-week-old infant. Seborrheic dermatitis may be differentiated from atopic dermatitis by its early onset, lack of pruritus, and absence of vesicles.

Atopic dermatitis, also known as infantile eczema, is very common in infants and begins at about 6 to 8 weeks of age. It is characterized by dryness of the skin, pruritus, erythematous papules and vesicles, serous discharge, and crusting. The usual site in children 6 months of age is the face (Fig. 24-28), with the nose commonly spared (the headlight sign). The extensor surfaces of the arms and legs are the most common sites in 8- to 10-month-old infants, as seen in Figure 24-29. Notice the exudative lesions on the lower extremity. Patients with atopic dermatitis tend to have an extra groove of the lower eyelid, called the atopic pleat. This feature is shown in the 6-month-old child with atopic dermatitis in Figure 24-30.

Are any vascular lesions present?

Palpate the skin and assess skin elasticity. Pull up 1 to 2 inches (2.5 to 5 cm) of skin over the abdomen and release it. It should quickly return to its former position. A decreased response is termed tenting and is suggestive of dehydration or malnutrition. Skin that seems

*There is evidence that even under 6 months of age, other means of measurement may be valid.

Text continued on p. 777

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