Skin Necrosis in Children: Physical and Infectious Causes

A chapter on skin necrosis is essential in pediatric age, a period of life that includes premature babies, infants, toddlers, teenagers, adolescents, and near adults. Especially in the very early ages, the immaturity of the skin and its still fragile development determine more rapid, fast, and aggressive necrosis more rapidly prey to aggressive infections up to generalized sepsis. In this phase of life, great attention is required to the primary prevention of skin breakdown, to the recognition of congenital or connatal lesions and their immediate treatment. Every small sign of skin or musculocutaneous damage requires in-depth investigations to discover any genetic diseases, rare diseases, and dysmetabolisms often associated with rapid onset, evolution, and coalescence skin necrosis. Pediatric skin necrosis are therefore a sign of extravasation but also of pharmacological damage and when discovered they must lead to a wider revision of the protocols inherent to various procedures. The poor response of the surface immune system of children, together with a generic immunocompromised situation typical of the age, make the foci of skin necrosis rapidly expanding, often coalescing with each other and capable of deepening up to and beyond the limits of the soft tissues.