Vernix caseosa

Major points
• Common finding in the neonatal period
• Characteristic white to gray, greasy covering on the
skin surface of the newborn (Figure 2.1)
• Thickness increases with gestational age
• Considered a protective covering and mechanical
barrier to bacteria
• Lipid composition is variable depending on
gestational age
• Discoloration and odor can indicate fetal distress
and/or intrauterine infection
Pathogenesis
• Composed of shed epidermal cells, sebum and
lanugo hairs
• Variable lipid composition of cholesterol, free fatty
acids and ceramide
Diagnosis
• Clinical diagnosis
Differential diagnosis
• Ichthyoses (disorders of keratinization) if atypical
Treatment
• None needed
Prognosis
• Sheds without therapy during the first week of life
References
Hoeger PH, Schreiner V, Klaassen IA, et al. Epidermal
barrier lipids in human vernix caseosa: corresponding
ceramide pattern in vernix and fetal skin. Br J Dermatol
2002; 146: 194–201
Joglekar VM. Barrier properties of vernix caseosa. Arch Dis
Child 1980; 55: 817