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I hope that's a yes. The silence hopefully means a yes. So this is a down that series for students by students showing you conditions in skin of color. It's supposed to be really simplified and just a short introduction into being able to recognize how common conditions present in skin of color. So just a quick structure, we'll be going through neonatal rashes. So that'll be um erythema toxicum, neonatorum, Meera, seborrheic dermatitis, atopic dermatitis, neonatal acne congenital melanocytic nevi acne vulgaris, capillary malformation and infantile hemangioma. So just a quick set of learning objectives to just have awareness of today's conditions and skin of color. Be able be able to correctly answer SBA S on today's topics and to be aware of the diagnosis and management of today's conditions. Uh So starting off um all the slides kind of have a really simple structure. What is it, the description, investigations and management? So, um starting with erythema toxicum neonatorum um or simplified as ETN. So what is it? So, erythema toxicum neonatorum is a benign transient rush. So, meaning that it's, it's harmless, it's not um a tall malignant and it lasts for a very short period of time and it normally appears in the first few days of life. So um after an infant, so after a baby is born, it normally um appears for a day or two and then it just naturally kind of just fades out. Um and it does affect quite a lot of newborns. So it's nothing to be really worried about. It affects about half of all newborns. So the description, so in sort of paler skin, um or sort of like lighter skin color and the babies may develop a small yellow or white papule and that is surrounded by a red halo on the face and trunk. Um and in sort of darker skin tone, you might just see rather it being a bit more, looks a bit more erythus and it looks like it's filled with a fluid. Um This fluid isn't pus, it's not full of pus. It does, it may appear to be to look a bit like like a comedo, which is kind of like what you see in acne. But um on close expect it looks more like it's full of fluid and not pus. So it doesn't look infectious at all. There is no infection. Um So investigations um so based on the clinical picture, so if it's a newborn, she recently born, it seems to just sort of appeared and it seems to be fading away. Um you can typically just diagnose it based on your clinical observations. So no other specific investigation are needed. Um And the management just reassure the mother and the father as well, they might be worried that it might be sort of a sign of something a bit more serious just to reassure them that this happens to half of the infants and it's self limiting, meaning it will just naturally sort of disappear. So no specific treatment is needed. Um Any questions. No. Um So as you can see, like for example, on a bit of the lighter skin tone, you do have sort of these, I guess, really sort of tiny, tiny, tiny papules that look like they could be full of pus, but they're actually full of fluid and they're really small and white or they can appear sort of yellowy color and they do have these sort of red sort of halos around it. So this is how it will appear and it's transient. So it'll appear for a few days and then it will disappear. Um Any questions? All right. So next we're gonna do malaria. So that sounds a bit like miliaria. Sorry. Uh It does sound a bit like malaria but very different miliaria. Um is a heat rash. So what is miliaria? Um Miliaria will sometimes ec miliaria is triggered by blocks, um equine sweat glands and ducts and this will cause backflow of these like of the sweat into the dermis um or the epidermis. So either the top layer or the layer just below of the skin and this is often seen in really hot and humid climates. So you might not. So where we are right now, I'm in England. You might not see it so much here. But where I was born in Ghana, you might see a little bit more commonly there. So it's parts of Sub Saharan Africa or maybe um sort of India sort of regions. Um So the description, so a newborn often presents with tiny red sweat filled vesicles on the neck and in the skin fold. So skin folds typically tend to be affected more just because of that accumulation of the sweat. Um and this is often exposure to a warm environment uh investigation. So yes, again, it's a clinical diagnosis. So you take a good history, you kind of have an appreciation of the location you're in, make sure you just have a full like head to toe and if it fits the picture of looking like um sort of the equine grands are full of sort of sweat and they look like the vesicles are full of these like sweaty liquid. Um and they're sort of in the the creases or folds, then you might be able to kind of appreciate it might be mi the area. Um So management so I guess is all sort of just preventative. So making sure that the baby is kept cool and dry is usually sufficient and it will go away and just make sure you're avoiding that excessive clothing and, um, so that I guess a sweat can just easily evaporate and, um, make sure that the heat exposure is minimized. So you just kind of give that as like advice to the parents, um, making sure that they're aware of the cause and what to do to prevent it. So this is how it looks like. Um, so kind of like, it looks like a bit like a heat rash. So it's kind of got this like prickly appearance all over the body. And I guess if you felt it, you'd feel like an appreciation of how it feels a bit p prickly and it tends to be in places that sweat a bit more. Um So in the baby, you might get it and the creases a bit more and it just does appear to be a bit more like a heat rash appearance. So like this. So next, we're going on to seborrheic dermatitis. Um But in specifically in babies, um they might be known as cradle cap. Seborrheic dermatitis also appears in adults as dandruff. So that's the term for dandruff in adults. Um But in Children, it might be called cradle cap. Um So cradle cap is a Seborrheic dermatitis that affects specifically infants. Um It's of often really scaling and looks really greasy and a lot thicker than in um in adults adults, usually the dandruff is a bit lighter, it's a bit, it's more white, sort of flaky skin infants is a bit more yellowy, thick scaly and crusty. Um and then in depending on the different shades of skin, um it may be a bit lighter. So, so whiter color or it may take a bit more yellowy and brown, just depending on the natural complexion of the person. So if they have a darker complexion, it might um be more sort of browny yellow appearance and it might be more of a white yellow appearance with more lighter skin. Um people of color. Uh So description. So in white people, it's typ it typically, so the non flaking parts typically appear red and e erythema, but the actual scaling part of it is greasy and that, that's the one that can kind of differ in color from white all the way to brown with hints of yellow in it. Um So it's affected um Oh sorry what I was gonna say. Um Yeah. So in skin of color, uh you might not see that redness um and you might not be able to appreciate that redness. Um So these patches tend to occur on the scalp where there's a, it's kind of the scalp is where there's a lot of sun cell turnover. So you might be able to see more pee on the scalp and then I guess we're talking about sort of like the, I guess the head extremity. So your face is a little bit on the chest but not so much. Um Some of the skin folds like in around the neck, you might get a lot of skin folds, but I would say mainly appears on the scalp. Um And yeah, like I mentioned, dandruff is considered to be like a milder, a milder form of sever thit which you may see in adults. Uh Yes, again, so all of these kind of um so far for the I guess the infant section of this lecture uh based on clinical diagnosis, no specific investigations are required, just take a history, have a good examination, make sure you're looking at all the ar areas and if the picture kind of matches you can kind of diagnose it as cradle cap. Um So the management so often it's by just gentle washing of the affected areas, making sure it's dry after and then applying some mineral oil which can like help soften the scaly bits, um making it easier to remove. So now you can see kind of what I mean by it kind of looks quite crusty and the kind of different varied shades of yellow either from like a lighter white, yellow to kind of like a darker brown yellow in these big pictures. Um and they kind of just look very crusty and they, I guess you can see that cradle cap is quite clear to see. It does look a bit daf it looks kind of like a se dermatitis. Um and it kind of fit fits that clinical picture. So what you need to do after diagnosing, it is just um advise the parents to make sure they wash it um thoroughly and they're applying sort of oils. Uh Next, something we're all quite common with is eczema. Um So the proper word for eczema would be atopic dermatitis. Uh What is atopic dermatitis? So, atopic dermatitis is a chronic itchy dry skin disease to its core. Um And in infants, it might be associated with a rash. Um and it tends to um start in infancy. And typically, um I guess if you're doing this for exam purposes, it may appear as like an atopic triad, meaning um I guess there's key conditions that come together. So if the patient in the clinical question has signs of eczema, any signs of allergies. So like conjunctivitis or rhinitis, meaning kind of like, I guess like kind of weeping yellow eyes. Um and they kind of get it around like hay fever season, for example, as a sinus allergies or they tend to get really sort of kind of itchy throat, um that kind of like, you know, triggers them around certain times of the year such as uh springtime, that kind of shows signs for allergies or they have other quite big well known allergies like peanut allergies or they have um asthma um diagnosed after five years old. Typically, um, those are key signs that I guess there's a whole A to B picture and eczema could be um a part of that. Uh So the description, so it tends to vary quite a lot. Um So, for example, it could be a bit more erythema meaning red, but in the skin of color, it tends to appear more hyperpigmented. So you're not gonna get that red, um redness, you're gonna get more er so whatever your natural skin color tone is, is going to be hyperpigmented, meaning it's going to be darker than the other areas that are unaffected. Um And then as it develops um from this rash, it kind of ends up being more crusty and exudative meaning sort of, it just has a bit more like fluid to it and it looks a bit more crusty. Um and it tends to weep, meaning if you kind of peel at it, it, it might start to kind of like pour out some fluid. Um There also may be some blisters. So this might be the, these scores which are kind of smaller or below, which are a bit more bigger in size. Um And I guess over time, this condition tends to be quite chronic and you might actually end up seeing thickened parts, so thickened parts, um being um like lynch effect parts, um which kind of uh develops sort of uh 0.5 millimeters above the skin and it's really scaly and really thick. Um and that tends to happen in a lot of um eczema patients as they get older. Um But Yeah. So, but in Children, uh, eczema tends to appear in slightly different places than so, in younger Children, it tends to appear in, like on the cheeks is a really key bit or on the arms or the trunk. But in older, um, older, I would say older Children. So maybe teenagers, they tend to get it in the, um, flexor surfaces. So like the back of their knees or like, um, I guess like in their like armpits, for example, or, um, kind of like in front of their elbows. Um, so, yeah, investigations. So it kind of depends. So if you're just kind of thinking it's a bit more isolated, you might just do it based on clinical diagnosis. But if you're thinking it's part of like more of an atopic picture and you're worried about extensive, like allergies, you might consider doing allergy te testing in more severe cases. Um, management kind of ranges based on severity. So, Emmo, that are kind of over the counter Emmo could be things like savvy e 45 like dove moisturizing creams. So all these are just normal over the counter, um, Emmott that you can get however kind of for more severe cases, you might use very low potency sero creams in Children. So we're thinking like 0.05%. So, like you is one that's typically used. Um, but depending on, I guess the age of the child. So if they're more like a teenager you might go to a low potency at 0.1%. Um and just see how that works. But steroid creams, you really wanna make sure you like, you're tapering it and you're kind of aware of the um local effects it has on the skin. Um And then obviously, typically it's things like just making sure you're avoiding, you're um advising the patient to avoid the known triggers. Um So that's typical of what you would do in any sort of atopic picture. If you avoid the triggers, then you tend not to get the um signs and symptoms of the disease. So this is quite a nice scale of kind of how um eczema might appear on ranging different tones of skin of color. So kind of here, like you can see it's around the mouth of the baby, kind of just around the chin and then going a little bit up to the cheeks here, you've got kind of like the flexor surfaces around the neck. Uh Here in the baby, you've got it around the knees and then back here around the mouth. So in the face kind of almost going to the cheeks and then here you got it around the elbows of the baby. And this one I'm suggesting probably would be a little bit of like an older child just because you can appreciate how it's a bit more thickened and it looks a bit more scaly. So it looks like it's more of a chronic picture um and looks more like um like lichen vacation has happened here. Uh Any questions? Ok. Ok. So neonatal Acne um also known as Acne Neonatorum is an acne form eruption that occurs in newborns or infants within the 1st 4 to 6 weeks of life. Um And these often appear as either open or closed comedones. So, um you might know them as whiteheads or blackheads. Um It kind of just depending on if they contain pus or not. Um So I guess it depends on the skin and the original color, but it may be small, it may be red depending on the skin tone, er but they definitely clear pimple like lesions or bumps um that appear and some of them will contain pus, some of the bumps won't contain pus yet and they often surrounded by like a dark brown ring. Um and the ones that contain pus will be called pustules. And if they don't contain pus, they might just be normal papule in Children. These are often around sort of the cheeks, chin, forehead and nose. So those common places to see acne uh investigations. So, clinical diagnosis again, it's quite clear to identify neonatal acne and management. So, in neonatal acne, this usually revolve um resolves on its own and there's no specific treatment needed. Um Later on this presentation will go into acne vulgaris, um which kind of occurs in more sort of like that preteen teenager um, picture and there are more different, uh, management options that you might need to consider, like, um, doing like a psychiatric analysis because, um, acne does tend to pose a lot more psycho dermatological, um, factors. Um, and you might have to consider more stronger, um, medications, but in neonatal, in neonates, so kind of like those really young babies, it's ok because it tends to just resolve on its own. Um, and as you can appreciate, it's quite clearly sort of acne picture. You've got those open and closed Comores here, you've got those um pustules full of pus on the forehead, nose cheeks, chin. So these are common locations. Um and like I said, it tends to appear on 4 to 6 weeks and it will resolve quite quickly. Ok. So, uh that's the end of the sort of neonatal bit where we went through some of the common things you might see um in neonates. Um Now we're gonna go on to congenital monocytic nevi C MN. Um So these are basically just pigmented birthmarks. Um and these are present from birth onwards. Um and these are often caused by a proliferation of melanocytes in the skin during fetal development. So, as a fetus, um those melanocytes which determine how pigmented your skin or certain areas of skin is um in that specific area, there is proliferation, which means like increased um growth and division in those areas of melanocytes. So there's more melanocytes. So it appears darker. So that's why it'll be a dark pigmented skin lesion from birth. Um So description um typically it's sort of brown or black and they kind of look like moles or like natural birth marks. Um And the patches vary in size. It can be really tiny, it could be really big. Um And they can, I guess be kind of clearly defined with borders, they can be a bit more irregular, but the key thing is they're present from birth. Um And sort of throughout your adult life, you've had them from the time you were born really. Um So some of these are common mole like lesions, they can look circular, they look a bit more like moles, others are large patches um with raised um surfaces, these are typically always smooth. So if you feel that it feels really smooth, they don't really feel like bumps. They, so they don't really feel like the papules or pustules. They don't really feel kind of like um sandpapery like or anything like that. They just tend to be smooth ray surfaces that kind of feel like they're just part of your skin and often times hair grows um with these lesions. Um So it kind of, it literally is just like a normal skin um that you've had since ac since you were a child and hair will grow from it. So that's just what it tends to look like. Um investigations. Uh Yeah, again, it is ty typically clinical. But for this, you might just want to uh use a dermatoscope just to have a magnified view of the lesion just in case it might be like a hemangioma or like anything else that might be a bit more worrying. Um So if you are worried that it might be something a bit more, uh like, I guess again, has malignant potential. You would take do a biopsy and kind of consider doing some more tests. Um But most of the time the malignancy assessment isn't needed unless there are atypical features. For example, if it doesn't feel smooth or um it it's like changed or developed over time um or like there seems to be more, more of it in a certain area or it just doesn't look right. Most patients say like, oh, it just doesn't look right. You know, I've had moles before I've had like these marks or this one just doesn't look right, then you might wanna um do a legacy assessment for it. So management really depends on the size um and type but typically small um C MNS um only require monitoring. So a dermatologist will typically monitor it and try to see if there are any changes um that are concerning. So, um typically you might use the typical melanoma like at e kind of thing just so like are the borders irregular or is it changing in size? Is it changing color? Is it discoloration? Things like that you want to make sure that it looks like it did. Um from birth, obviously, as a child grows, it might grow in size as well, but in proportion to its original size. Um so for larger ones, um or ones that are a bit more cosmetically problematic or in like certain areas that may make people feel a bit more insecure about the way they look. Um So in these like prominent areas, uh this can typically be addressed with surgical excision or laser therapy. And as always, sun protection is really, really important. It's important all the time, but especially for people with CM MS. Um it's really crucial just to reduce the risk of skin cancer. So um advising of sunscreen use and protective clothing. So I just have like an appreciation, it's kind of like whatever the normal skin tone is, but just a few sort of shades darker and it kind of looks like it's around the same thickness and level as the normal skin and whatever texture that normal skin is, it tends to be the same texture as the semen. Um And then if you can appreciate here, this is another C MN but it's also called like hair growth. So it's just part of the normal skin bio and then it's just normal hair growth here. Uh Sometimes there is uh like, so this is CMC MN here, but this is a cafe au um like macule um which tends to be uh present in like a, um, in a congenital, uh I guess cluster of diseases that tend to be cancerous. So, it's really important that if you're suspecting that it just looks a bit more different to the normal skin and it might be something like a cafe or a spot you might want to do uh like a malignancy screen and see if they have other like features that could possibly be malignant. Um So, moving on to acne vulgaris, which is acne often in non infants going through all the way from sort of pre teens teenagers and some early adults. Um some women sort of during kind of like high hormonal hormonal uh stages of their life might get acne vulgaris or for some reason how when they have dysregulated hormones. Uh but typically you might see these in teenagers. Um So acne vulgaris is a common skin condition, primarily affecting the pilo sebaceous unit. So this is just the hair follicles and the sebaceous glands in the skin. Its features are non inflamma, inflammatory Chromos and inflamma inflammatory lesions. So, papules, pustules, nodules and cysts, er, cysts tend to be, er, nodules and cysts tend to be sort of like a later feature. So, nodule cystic is a lot more extreme acne that tends to need more sort of like systemic treatment. Um but papules and pustules in like more sort of localized areas are more milder forms of acne. Um So where do these tend to appear, so they might tend to appear uh on the face, neck, chest, back, back, knee, if anybody's heard of that back acne and shoulders. Uh So how do they tend to look and how they tend to appear? Like I said, it tends to be in adolescence due to the hormonal changes. And because of this, there's increased sebum production and that causes uh the formation of um Chromos if that sebum gets like trapped in the skin. Um and these can be open or closed. So um black heads or white heads depending on that. Uh So the inflammation of the comones then causes papules, pustules, nodules and cysts kind of going in order of severity. So, papules kind of like the least severe all the way up to cysts which are quite like a severe feature of acne. Um And like I mentioned a bit before acne can significantly impact self esteem and quality of your life, especially in adolescents. So, just being aware of that and making sure you're screening for any psychiatric conditions that might come from it if they're especially like have more anxiety or depression. Um as a result of acne, they might have sort of social anxiety cos they don't wanna go out. So just making sure you're aware of that as well. Um Yeah, again, diagnosis is often clinical. So a lot of this is just making sure you're aware of how it appears who it appears in. And what it looks like. Um, other investigations could be things like hormone level assessments, uh, for like severe or atypical cases. So, like I mentioned in adult women who have never had a history of any sort of skin to like skin problems and they, they've had acne before and all of a sudden they seem to appear with something that looks a bit like acne, you might want to do like a hormone level assessment to see the bigger picture of what's going on. Uh management kind of ranges. So from like a lighter milder end, you can kind of inform about lifestyle changes. So gentle cleansing and dietary adjustments could be like something that you can just advise and see how it goes and then kind of going stepping up, you can use topical treatments. So treatments on the skin such as benzoyl peroxide or retinoids, which are quite useful and then going on to the more severe cases. Um you might wanna use oral antibiotics like Lymecycline is quite a good one. hormonal therapy. So the like the C OCP the Combidol contraceptive pill or for really quite severe cases, which are like nodular cystic ISOtretinoin is really, really effective. Um but has a lot of side effects and there's a huge purge in stage where the skin gets really, really bad when you start using it um for a few weeks and then it does get better. Um But I freshen her in, there's lots of monitoring needs to happen. Lots of blood tests. The um the child, teenager, young adult er, has to be on effective contraception as it can cause um sort of defects in er babies if they were to be conceived. Uh So just having appreciation of acne vulgaris kind of kind of more mild acne here on just the forehead, you can appreciate. There's like papules and pustules here. The pustules here, the papules around here does cause a bit of light hyperpigmentation around it. But this one's sort of like a milder form, then you might get some acne often around the cheeks. That's a common place that it can appear some hyperpigmentation and some um papules around here and then more towards the severe end where it's more nodular cystic. So like the nodules are coming together and forming these cotton like complexes that look a bit like cysts forming and this is more severe acne and you can see kind of like from the skin. There are sort of these features that um but the skin has probably gone through, maybe if someone has like been picking up the acne, you can see that skin has almost formed these sort of like, I guess reactive holes from that. Ok. So moving on to infantile hemangioma, what is it? Hemangiomas are the most common soft tissue tumors of infancy. So if you see something that looks a bit like a tumor and it's kind of sort of in like soft tissue areas, you're probably thinking it might just be a hemangioma. Um So, these are benign tumors um that do occur because of the dysregulation of vasculogenesis and angiogenesis. So, like the dysregulation of new blood cells in certain areas will cause um hemangioma. Um This leads to a build up a really quick, build up of blood vessels in a certain area. Um But typically, it's quite obvious it tends to appear on the head and neck. Um So it tends to start out of these faint red brown birth marks. Um but then they do have this distinct growing pattern. So um as opposed to the C MN, which doesn't really tend to grow, it grows in relation to how like the skin stretching, how like a you a normal passing grows. But uh hemangioma actually, it's like fluctuating and it actually has m growth phases. So it has a growth phase, it has a stabilization phase and it has a regression phase. So this is a benign tumor but it does grow and regress. So it will fluctuate in appearance. Um So they consist of clusters of small blood vessels and these can have varying appearances based on the prof proliferation of these blood vessels. So very little proliferation might be it's flat or slightly raised. Um and then really big proliferation may be deep seated, meaning it may um kind of build up way below the surface. So, in the dermis, um rather than just in the epidermis. And like I said, these ones will probably change in color based on the different phases. Um So investigations diagnosis often is clinical appear. However, additional imaging studies like ultrasound MRI or angiography may be considered for atypical cases where complications are suspected due to the depth or affecting nearby structures. And there's like an image where you later on where you can appreciate how some of these have a really deep depth. And you can app app appreciate how um local invasion of the structures, especially in the face where everything is so close together. Um Kind of having I guess a hemangioma grow quite deep, can affect structures in the face and cause maybe temporary blindness or like facial paralysis. So those ones um you might need to do like an MRI to appreciate the depth and the nearby structures that the um hemangioma is impinging upon. Um So the management really depends most of these will uh like I said, go through the phase where it will go through a growth phase, a stabilization phase and a regression phase. So most of these will regress spontaneously. Uh however, intervention may be needed for things such as the function impairment. Like I mentioned, like for example, vision loss or if you can see kind of like the eyes are kind of down and out or kind of there's a kind of like nystagmus. So any weird functional impairments, um ruction in vision or sometimes breathing issues. If it's around the neck area, it might impinge on the esophagus and cause breathing issues. I've seen one kind of on the lips and it might affect like eating. Um, sometimes if it's around the nose, it might affect breathing. So if it has any of those, um you might want to go for surgical excision or maybe laser therapy, but surgical excision more. But if it's more cosmetic topical treatments like prop propranolol and cortical steroids might be fine. But those are really severe cases. Most of the cases of infantile hemangioma will resolve without any treatment. Um So, yeah, so here we go. These are kind of different images of infantile hemangioma, but you can appreciate the range of how different they look, but all of them kind of look like it's some sort of proliferation of uh blood vessels in the epidermis and some of them like this one might be proliferation that's going all the way to the dermis and this might affect the baby in the way that they eat or breathe. So you might wanna do like an MRI to check this one but other ones um might not affect the baby so much. And here you can appreciate that on the lips. It might cause difficulty, visual issues and you might wanna do laser therapy or surgery for this. But the others might be fine to leave alone as they might regress naturally or you might put propranolol or steroids um, over these superficial ones. Uh, and then lastly capillary malformation, it's a bit similar to a hemangioma. Um, but typically, uh, they might know it as, um, like a port wine stain. So it's like a vascular bath mark, which is tends to be quite extensive and it tends to be flat. So it's never gonna be as raised as this. It's always, always flat and it kind of looks a bit like, imagine you pour wine on somebody's face, kind of looks like it's all kind of smothered all over and kind of like kind of not clear circular. It's really got kind of irregular borders, but it's quite smooth. Um So it's always flat and varies in color from pink red to kind of purple in color. This is caused by dilation of the capillaries. So, whilst the hemangioma was due to the proliferation, meaning more, more and more of these er capillaries um in the process of angiogenesis, this is this one's caused by the dilation of the capillaries. Um and it tends to be present at birth as well. In rare, rare rare cases, it may be linked to underlying syndromes and medical conditions, but that's beyond my scope for the kinds of conditions that are associated with. Uh So the description, so it's capillary malation due to that dilation of the capillaries and it's pretty much most often found on the face. Um it tends to persist through life um and it darkens and thickens but it's still flat. Um, so, yeah, investigations again, uh, a dermatologist will tend to diagnose it based on, um, inspection. You might do a wood's lamp, um, examination just to extent, um, assess the extent and the depth of the lesion. And if you're suspecting it to be hemangioma, you could do an MRI to just check that there is not any deeper involvement and to rule out any syndromes or excessive cases. Uh in some cases where you're worried that it could be part of the syndrome. You could do genetic test for things like Sturge Weber syndrome and Klippel CH CH which I haven't heard that before. Syndrome in multifocal malformations, um management obs observation is the first step you wanna observe, um observe how the lesion um regresses or expands. Um You'll tend to see it kind of just thicken and darken over time. So you don't, you don't tend to see um capillary malformations have those stages that hemangioma have. So tend to just stay as it is, but darken and thicken over time, it won't regress or get bigger or anything like that. Um So you wanna, yeah, so you wanna first observe, see how it is, make sure that the harmon um malformation is harmless. Um And then if that's fine and you're sure it's a malformation, a malformation, then there are just treatments. So it could be things like ca um camouflage makeup because it's quite thin and flat on the face, it's quite easy just to put a foundation or concealer on and that can conceal the birthmark quite easily. And most patients are happy of that as they get older. Um There are other things such as post dye laser therapy, um which kind of just is a cosmetic improvement to either reduce that redness or purple or pinkish hue to the skin kind of trying to match it to the natural skin color of that patient. And then uh there are other surgical options such as der abrasion, excision, skin grafts. Um just to uh treat those larger uh disfiguring malformations. And like I said, if you're worried that it could be part of any of those bigger syndromes, you just want to make sure that you're doing the genetic testing. Um If you suspect that so il malformations is you can appreciate, they're quite flat and quite extensive and they do have that like port wine appearance where it just looks like wine is kind of splashed all over the face. Um It's quite large, quite thin. Um And it just kind of appears like it's kind of dilated vessels. Uh This will just tend to darken as they get older and thicken a bit, but it's nothing to worry about. Ok. So time for some SBA S. So the question is a newborn infant develops a rash within the first few weeks of life presenting as a small yellow or white papules surrounded by a red halo on the face and trunk. The rash is characterized by small fluid filled bumps with no pus. What is the most likely diagnosis? Um I have the chat opening. I think the chopper player. I think the right uh if they are likely to recur. Oh, sorry. Um Phillipa Blake was the question, sorry for the capillary malformation or was it for the hemangioma? Um Does, do you guys wanna, I'll give you about a few minutes to think th through this. Um And then we'll answer it in two minutes. So at 6 49 I'll go through the answer. B so I got one answer for B in the chat. Does anybody agree or disagree with that be Nana? Wa that seems good. Anybody else think it's B or do you think it's something else? B Chloe? Really good? It was for the hemangioma, the larger growth. Uh Sorry, one second these, no hemangioma won't tend to grow back. Um I think once, once the surgery, if you do surgery, I think once it's removed and those uh vascular lesions are removed, um I don't think they would tend to grow back. You're welcome. OK. So should II might just reveal early really good. So most of the chat has gone with B erythema Toxicum Neonatorum. Um which is the correct answer. So, uh the scription of a small yellow or white papules surrounded by a red halo on the face and trunk, the small fluid filled bumps, um, aligns with the characteristics of ETN. Um So ETN would be from the first few days of life. Um and it tends to be transient and has this picture with no pass. So if it had um kind of it looked like it had passed, you might be thinking neonatal acne because it has none of this and it's within the few days of life, you're thinking ETN. Ok. Uh So the next one, a six month old infant presents with a distinct red brown birthmark on the head, the birthmark has gone through a growth phase appears raised and is composed of clusters of small blood vessels. What is the most appropriate management for this condition? So this is two steps. So you've gotta think of what the diagnosis is, diagnosis is and then think about what might be the best um management also considering the age of the infant and whether we've seen the entire process. So just consider those things. Um I'll give about a minute to answer that. So what does really think I've got the chat open? Um So, oh Tishia mentor. Um yes, you will get the slides um after um and if you can't use a chat, just feel free to unmute yourself and speak. OK. You've got some a s 10 more seconds. What does that really think? 10, 987654321. OK. A or C Yeah, I mean that those were the thoughts I had A or C, um, because I, I mean, I guess so with an SBA, so the answer is a, um, the reason why I would say that it's really tricky is just because sometimes in exams it might say management instead of investigation. If it said investigation I'd probably think. Do I need an ultrasound to confirm for diagnostic confirmation? Well, it's so, it's distinct, it's spread around and it says it's a birth mark on the head. Um And I'm assuming if it's six months old, the parents have said that it's been there since a child, since they were um a newborn. Um And it says that it's go, it's gone through a growth phase, it appears raised, it's composed of these clusters. I'm a, I'm assuming they might have done sort of like dermatoscope investigation now already. And it does seem to kind of fit into the picture of a hemangioma. Um And would ultrasound basically would ultrasound add to how this was managed? Not really if the ultrasound did confirm it, it wouldn't really change the management any more than um what would already happen. You were probably already going to observe and reassure and see how it develops, right? So if it kind of goes through that growth phase and then it kind of goes through that regression phase um towards the end, then you, you, it's confirmed that it is a hemangioma and that's fine. If it doesn't, then you'll be thinking of those other investigations like an ultrasound or an MRI later on, but there's no worrying features. They don't seem to have any kind of like local functional impairments or anything like that. They haven't mentioned that the child has any other signs of any other like clusters of congenital like cancer syndromes at all. So just I might just observe and reassure the parents and see how it develops um, over time. Oh, And like I said, like I said, most of the hemangiomas regress and they completely go away after time. So observation and reassurance tends to be the best option. Um So just a recap of the lesson went through the neonatal rashes, erythema, toxicum, neonatorum, malaria, seber dermatitis, atopic dermatitis, neonatal acne congenital melanocytic nevi acne vulgaris, capillary malformation and infantile hemangioma. Hopefully, you have an awareness today or just how these conditions may present on skin of color based on the images that you saw, uh you'll be able to correctly answer some S pa s on today's topics and you can perform quite a good spot diagnosis. Hopefully um based on today's topics based on the images you've seen. Uh That's the end. This is our sort of QR code for our society's link tree in there. There are just some different things that we do. Um We have an abstract competition coming up soon and we have loads of really cool events. Um This was the end, I'm queer sa I'm the President of the African Caribbean Medical Society at King's College London. And I hope you enjoyed the Dermatology lecture series. Uh Let me know if you have any questions before it ends and please remember to s uh fill out the feedback form. Thank you very much.