Pediatric emergency medicine trisk 1340 1340
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epidermolysis bullosa. Antithyroid drugs, most notably methimazole, have been
implicated in some cases of aplasia cutis congenita.
Indurated Plaques
Subcutaneous Fat Necrosis
Subcutaneous fat necrosis is a condition seen in usually term infants with the
development of freely mobile nodules and plaques with or without redness. They
usually appear within the first 6 weeks of life and are usually limited to areas of
trauma or ischemia during delivery. These can be asymptomatic or mildly tender.
Risk factors include high birth weight, prolonged labor, neuroprotective cooling,
and other ischemia. The most common locations are the back, buttocks, and
cheeks. Lesions resolve spontaneously in weeks to months. Mild atrophy of the
skin may be noted after resolution. Complications include hyper- or
hypocalcemia, lactic acidosis, high levels of ferritin, and transient
thrombocytopenia; hypercalcemia is the most common. For extensive lesions,
serum calcium, phosphorus, parathyroid hormone, and vitamin D levels should be
monitored and patients should be observed closely for irritability, vomiting,
anorexia, renal failure, or failure to thrive in the first 6 months. Pamidronate and
low-calcium formula are used in severe cases. In most cases, reassurance is all
that is needed.
Vascular Patches/Plaques and Hamartomas
Acute Hemorrhagic Edema of Infancy
Acute hemorrhagic edema of infancy is a distinctive, cutaneous small-vessel
leukocytoclastic vasculitis of young children. Dark purple or pink in color,
somewhat annular patches and plaques, without surface change, occur mostly on
the face and extremities ( Fig. 69.14 ). Infants otherwise look well and are usually
afebrile or at most have a low-grade fever. Visceral involvement is uncommon,
and spontaneous recovery usually occurs within 1 to 3 weeks without sequelae.
The main differential diagnosis is Henoch–Schönlein purpura.
