Thos infants that are found should have a focused reassessment, a thorough family history, and continued examination of the hair (Furdon & Clark, 2003). The clinician must also have a good understanding of the embryological development and cycles of hair growth, as well as an understanding of abnormal conditions. This paper will discuss a few of those conditions that might be seen in the newborn and young child.
Aplasia Cutis is a rare condition in which there is a congenital absence of the skin, usually presenting on the scalp (Beckman, Griot, Niessen et.al., 2008). It can occur anywhere in the body but most often occurs at or near the scalp vertex and appears to be a single or sometimes multiple non-inflammatory patch of absent skin. It can vary in shape and size and how deep it is (Huang, Llang, Hu,et.al., 2009). In about 20% of reported cases, part of the skull is also missing. The area may be pink or red and oval or round and may have a smooth, atrophic or papyraceus surface (Savoia, Giacomini, Aprile, et.al., 2008). If the child is seen for the first time later, there may be hypertropic scarring where any healing takes place.
There are two different clinical presentations of this particular disease. Membranous which is believed to be a mild form of tubal closure defect and non-membranous which is irregular. In both cases this is a sporadic disorder with a rare familial distribution (Huang, et.al., 2008). The average child is Caucasian of Italian origin.
Aplasia Cutis may appear isolated or with other anomalies and frequently appears when there is also a nervous system defect. It sometimes appears with epidermolysis bullosa and deformed nails and occasionally with congenital heart lesions. In the case of membranous, there is possibility that it represents a mild neural tube defect. The difference in membranous and non-membranous may be the difference in pathogenic effects in the formation of the scalp. It may appear with Adams-Oliver syndrome in which there is a combination of congenital aplasia cutis and anomalies of the extremities and vessels , especially in the skull (Beckman, et.al., 2008)
The severity of the disease when the child is born will determine what needs to be done next. In some cases the lesions will have already scarred over, in others tissue expansion will need to be done. Full thickness skin grafts can be used in those cases where necessary. If the defect is minor, most heal readily. It is recommended that topical antiseptic or topical antibiotics be used however to prevent infection while healing. There may need to be later treatment of hair transplant and there may be a need for some plastic surgery later in life based on the scaring that takes place. When using a non surgical approach there are recommendations for Omniderm with absorbent fine mesh gauze impregnated with 3% bismuth tribromophenateridin for cranial defects and the use of permeable polyurethne film in others.
Certainly a full work up and follow up on these children, other than the skin lesions is necessary to assure that there are not other problems to be cared for or stabilized over their lifetime. Those can most often include neurological disorders as well as cardiac disorders.
Nevus Sebaceous is difficult to differentiate from aplasia cutis. Nevus Sebaceous is