Disease | Description | Course | Treatment | Other |
|---|---|---|---|---|
Erythema toxicum | Erythematous macules, papules, pustules, vesicles, or wheals on the face, torso, proximal limbs, and buttocks Spares palms and soles | 24–48 h after birth, may be seen ≤2 wk of age Resolve spontaneously and heal without sequelae | None | Affects 50% of full-term neonates Eosinophils on Wright’s stain of pustules |
Transient neonatal pustular melanosis | Fragile, superficial pustules; no erythema After rupture → collarette of scale and hyperpigmentation Widespread, including the palms and soles | Present at birth Hyperpigmentation may last several months | None | Affects darker-skinned, full-term neonates Sterile subcorneal neutrophilic pustules |
Miliaria crystalline | Small, flaccid vesicles on the forehead, neck, upper trunk, and occluded areas | Sometimes present at birth | Avoid overheating and overswaddling | Caused by obstruction of eccrine sweat ducts near the surface of the skin |
Miliaria rubra | Small erythematous papules and pustules on the forehead, neck, upper trunk, and occluded areas | Usually after first wk of life | Avoid overheating and overswaddling | Caused by obstruction of eccrine sweat ducts in the deeper layer of the epidermis |
Milia | 1- to 2-mm white or yellow epidermoid cysts usually on the face | Usually resolve by age 1 mo | None | If seen on palate, known as Epstein’s Pearls. |
Neonatal cephalic pustulosis (neonatal acne) | Discrete, noncomedonal papules or pustules on an erythematous base Usually on the cheeks; also on the forehead, chin, eyelids, neck, upper chest, and scalp | Onset during first 2–3 wk of life; spontaneously resolves within weeks | None necessary; may be improved with topical clotrimazole | May be caused by Malassezia spp. |
Acropustulosis of infancy | Crops of acral, pruritic vesicles and pustules on the hands, wrists, feet, and ankles | May present in the neonatal period but usually at 3–6 mo of age Last 1–2 wk and recur in 3–4 wk Less frequent relapses with age; complete resolution usually by age 3 yr | Topical corticosteroids or oral antihistamines If severe, consider dapsone Some pts respond to oral erythromycin | Must exclude scabies (burrows, genital involvement); microscopic exam of scraping |
Nevus sebaceous | Hairless, thin, orange plaque on the scalp or face; may be seen on the neck or trunk | Progressive thickening and a verrucous appearance | Observation; complete excision for cosmesis | <1% develop secondary basal cell carcinoma |
Congenital melanocytic nevus | Tan or brown, oval plaques; sometimes hairy | Commensurate growth with age; occasionally regress May become verrucous with pigment changes | Yearly skin check for changes Consider bx and excision based on clinical changes, melanoma risk, location, age, and FH | Giant nevi with greater risk of melanoma progression Neurocutaneous melanocytosis with some larger scalp or axial lesions |
Nevus simplex or macular (vascular) stain (salmon patch, angel kiss, stork bite) | Salmon pink, vascular patch commonly on the forehead, upper eyelids, or nape of the neck May become more prominent with crying; blanches with pressure | Most fade or resolve spontaneously, but neck lesions usually persist | None necessary; pulsed-dye laser for cosmesis | |
Mongolian spot (dermal melanocytosis) | Bluish patches often on the lumbosacral or buttock areas Seen more commonly in patients with darker skin and Asians | Most fade with time | None | Document in newborn skin exam to avoid misdiagnosis of bruising or child abuse Diffuse or unusual distribution may suggest systemic involvement (eg, storage disease, phakomatosis pigmentovascularis) |
Disease | Description | Clinical Course | Treatment | Other |
|---|---|---|---|---|
Neonatal lupus erythematosus | Annular plaques with raised, red borders and central clearing Predilection for the face (especially periorbital area) Photosensitivity | Typically resolve without scarring Dyspigmentation may persist for months May have residual telangiectasias | Evaluate for internal manifestations: Congenital heart block (ECG), hepatobiliary disease (LFTs), thrombocytopenia (CBC), CNS | Almost all have anti-Ro antibodies; may also see anti-La or U1RNP antibodies Cardiac NLE: 20% mortality; two-thirds require pacemakers |
Lamellar ichthyosis | Collodion baby: Taut, shiny erythematous skin → scaling, fissures, superficial desquamation Ectropion Eclabion Hypoplastic nasal and auricular cartilage | First few weeks: Collodion membrane replaced with large platelike scales, superficial fissures Scalp scaling ± scarring alopecia ± nail dystrophy Ear canals occluded with scales → recurrent ear infections Obstructed sweat ducts → heat intolerance |
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Bullous congenital ichthyosiform erythroderma or epidermolytic hyperkeratosis (EHK) | At birth: Erythroderma, erosions, peeling, denuded skin Later: Severe hyperkeratosis | Blistering episodes, secondary bacterial infections, disfigurement, malodor ± scarring alopecia | ||
Nonbullous congenital ichthyosiform erythroderma | Collodion membrane at birth Ectropion Eclabion | Collodion membrane replaced by generalized erythroderma with persistent scaling (variable severity) Nail dystrophy Obstructed sweat ducts → heat intolerance | ||
Harlequin ichthyosis | Thick, platelike scale with extreme ectropion, eclabion May see autoamputation of distal digits | Usually premature and may die within days to weeks because of complications Delayed growth and development if the patient survives past infancy | ||
Netherton syndrome | Generalized erythroderma, scaling May have sparse abnormal hair | Failure to thrive Atopic diathesis Ichthyosis linearis circumflexa: Serpiginous migratory annular or polycyclic rash with double-edged scale (usually after age 2 yr) Improves with age; intermittent flares | Emollients, keratolytics, retinoids, corticosteroids Increased caloric and protein requirements Antibiotics for infection | |
Epidermolysis bullosa (EB) | Ranges from mild blistering to generalized flaccid bullae or erosions → scarring, contractures, pigment changes ± eye, oral mucosa, GI, GU involvement | Onset at birth or early infancy Secondary infections common High incidence of squamous cell carcinoma → death (RDEB) Upper airway obstruction (JEB > RDEB) | Gentle cleansing Nonadherent dressings and topical antibiotics for erosions Loose-fitting clothing Cool environment | Increased caloric and protein requirements Varied mutations |
Ectodermal dysplasias | May see desquamation, erythroderma, hyperkeratosis, erosions as neonate Abnormal hair, teeth, nails (partial or complete) | Hair, nail, teeth, sweat gland abnormalities Hyperthermia Ear anomalies ± Cleft lip or palate ± Limb anomalies | Gentle cleansing Bland emollients Nonadherent dressings and topical antibiotics for erosions | Secondary infections of erosions common Genetics referral for counseling |
Staphylococcal scalded skin syndrome | Superficial bulla with desquamation Perioral crusting Diffuse tender Erythema No mucous membrane involvement | Prodrome: Fever, malaise, irritability Scaling or desquamation for 3–5 d after bullae formation Reepithelialization in 10–14 d | Parenteral antibiotics Bland emollients for denuded skin | Frequently seen in diaper area in infants |
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