Curbside consultation in pediatric dermatology by editor, James R. Treat.

By editor, James R. Treat.

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Hypomelanotic conditions of the newborn and infant. Dermatol Clin. 2007;25(3):373-382, ix. 7 QUESTION HOW DO I EVALUATE TAN BIRTHMARKS? Patrick McMahon, MD The vast majority of tan birthmarks are inconsequential; however, there are certain physical examination features that can alert a physician to the possibility of an underlying genetic syndrome or systemic disease. For the purpose of this review, the term birthmark will include those lesions noted at or soon after birth, as some pigmented birthmarks can be present, but are less noticeable, at the time of birth.

In association with a second cutaneous marker, a vascular stain does warrant an evaluation for spinal dysraphism. A sacral dimple is one of the most common cutaneous abnormalities identified on lumbosacral skin examination. 5 cm from the anal verge. Also referred to as a coccygeal pit, these lesions are not considered markers of occult spinal dysraphism. On the other hand, an atypical dimple is a strong predictor of underlying dysraphism. 5 cm from the anal verge, off-midline in position, or wider than 5 mm in diameter.

Young infants, especially preterm infants, are at greater risk for systemic absorption of topical medications because of an increased surface area to volume ratio and because of impaired skin barrier function. Finally, the presence of ulceration on the surface of IH may increase the risk of systemic absorption of medications. Ultrapotent topical corticosteroids have been used to treat superficial hemangiomas with a variable response. 4 Imiquimod, a topical immune modulator that is approved for the treatment of genital warts and actinic keratoses in adults, is reported to be effective for treating small superficial IH.

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