Section 1. Cutaneous Findings in the Newborn

Vernix Caseosa

Vernix, derived from the same root as varnish, is the whitish-gray covering on newborn skin and is composed of degenerated fetal epidermis and sebaceous secretions.

Epidemiology

Age Newborns.

Gender M = F.

Prevalence Seen in all infants.

Pathophysiology

The vernix caseosa is thought to play a protective role for the newborn skin with both water-barrier and antimicrobial properties.

Physical Examination

Skin Findings

Type of Lesion Adherent cheesy material which dries and desquamates after birth (Fig. 1-1).

Color Gray-to-white.

Distribution Generalized.

Differential Diagnosis

The vernix caseosa is generally very distinctive but must be differentiated from other membranous coverings such as collodion baby and harlequin fetus. Both of these are much thicker, more rigid, and more dry.

Course and Prognosis

In an otherwise healthy newborn, the vernix caseosa will fall off in 1 to 2 weeks.

Treatment

No treatment is necessary. Much of the vernix caseosa is usually wiped from the skin at birth. The rest of the vernix is shed over the first few weeks of life.

Current newborn skin care recommendations are as follows:

1. 1. Full immersion baths are not recommended until the umbilical stump is fully healed and detached.

   2. At birth, blood and meconium can be gently removed with warm water and cotton balls.

   3. Umbilical cord care and/or circumcision varies from hospital to hospital. Several methods include a local application of alcohol (alcohol wipes), topical antibiotic (bacitracin, Polysporin, or neosporin), or silver sulfadiazine cream (Silvadene) to the area(s) with each diaper change. The umbilical cord typically falls off in 7 to 14 days.

   4. Until the umbilical and/or circumcision sites are healed, spot cleaning the baby with cotton balls and warm water is recommended. After the open sites have healed, the baby can be gently immersed in lukewarm water and rinsed from head to toe.

   5. Avoiding perfumed soaps and bubble baths is best. Fragrance-free, soap-free cleansers are the least irritating. Such cleansers should be used only on dirty areas and rinsed off immediately.

   6. After bathing, newborn skin should be patted dry (not rubbed). The vernix caseosa may still be present and adherent for several weeks. Topical moisturizers are usually not recommended.

Cutis Marmorata

A physiologic red–blue reticulated mottling of the skin of newborn infants. It is seen as an immature physiologic response to cold with ...