Benign skin and scalp lesions in the newborn and young infant
- Josie A Pielop, MD
Josie A Pielop, MD
- Clinical Assistant Professor of Dermatology
- Baylor College of Medicine
- Section Editors
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Professor of Pediatrics and Medicine
- Dell Medical School/University of Texas, Austin
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
Benign skin lesions in the newborn are reviewed here. Blistering conditions in the newborn caused by infection, congenital abnormalities, infiltrative disease, vascular lesions, and congenital nevi are discussed separately. (See "Vesiculobullous and pustular lesions in the newborn" and "Skin nodules in newborns and infants" and "Vascular lesions in the newborn" and "Congenital melanocytic nevi".)
Benign vesiculopustular lesions — Although most vesiculopustular eruptions in newborns are benign and self-limiting, the differential diagnosis includes conditions that require prompt recognition and/or therapy (table 1). (See "Vesiculobullous and pustular lesions in the newborn".)
Erythema toxicum neonatorum — Erythema toxicum neonatorum (ETN) occurs in 31 to 72 percent of full-term infants but declines in incidence with decreasing birth weight and gestational age . The etiology is not known, but immaturity of the pilosebaceous follicles (the combined sebaceous gland and hair follicle) may contribute .
ETN is characterized by multiple erythematous macules and papules (1 to 3 mm in diameter) that rapidly progress to pustules on an erythematous base (picture 1A-B) . The lesions are distributed over the trunk and proximal extremities, sparing the palms and soles. They may be present at birth, but typically appear within 24 to 48 hours. The rash usually resolves in five to seven days, although it may wax and wane before complete resolution .
The diagnosis of ETN is usually made upon the basis of clinical appearance. It can be confirmed by microscopic examination of a Wright-stained smear of the contents of a pustule that demonstrates numerous eosinophils and occasional neutrophils. However, this usually is not necessary. A minority of patients (7 to 18 percent) may also have peripheral eosinophilia .
- Carr JA, Hodgman JE, Freedman RI, Levan NE. Relationship between toxic erythema and infant maturity. Am J Dis Child 1966; 112:129.
- Treadwell PA. Dermatoses in newborns. Am Fam Physician 1997; 56:443.
- Cutaneous disorders of the newborn. In: Hurwitz Clinical Pediatric Dermatology, 3rd ed, Paller AS, Mancini AJ (Eds), Elsevier Saunders, Philadelphia 2006. p.17.
- Berg FJ, Solomon LM. Erythema neonatorum toxicum. Arch Dis Child 1987; 62:327.
- Ramamurthy RS, Reveri M, Esterly NB, et al. Transient neonatal pustular melanosis. J Pediatr 1976; 88:831.
- Barr RJ, Globerman LM, Werber FA. Transient neonatal pustular melanosis. Int J Dermatol 1979; 18:636.
- Katsambas AD, Katoulis AC, Stavropoulos P. Acne neonatorum: a study of 22 cases. Int J Dermatol 1999; 38:128.
- Transient benign cutaneous lesions in the newborn. In: Neonatal Dermatology, 2nd ed, Eichenfield LF, Frieden IJ, Esterly NB (Eds), Saunders, Philadelphia 2008. p.90.
- Niamba P, Weill FX, Sarlangue J, et al. Is common neonatal cephalic pustulosis (neonatal acne) triggered by Malassezia sympodialis? Arch Dermatol 1998; 134:995.
- Bernier V, Weill FX, Hirigoyen V, et al. Skin colonization by Malassezia species in neonates: a prospective study and relationship with neonatal cephalic pustulosis. Arch Dermatol 2002; 138:215.
- Ayhan M, Sancak B, Karaduman A, et al. Colonization of neonate skin by Malassezia species: relationship with neonatal cephalic pustulosis. J Am Acad Dermatol 2007; 57:1012.
- Disorders of the sebaceous and sweat glands. In: Hurwitz Clinical Pediatric Dermatology, 3rd ed, Paller AS, Mancini AJ (Eds), Elsevier Saunders, Philadelphia 2006. p.185.
- Rapelanoro R, Mortureux P, Couprie B, et al. Neonatal Malassezia furfur pustulosis. Arch Dermatol 1996; 132:190.
- Hoath SB, Narendran V. The skin. In: Neonatal-Perinatal Medicine, 9th ed, Fanaroff AA, Martin RJ, Walsh MC (Eds), Elsevier Mosby, St. Louis 2011. p.1705.
- Cunliffe WJ, Baron SE, Coulson IH. A clinical and therapeutic study of 29 patients with infantile acne. Br J Dermatol 2001; 145:463.
- Barnes CJ, Eichenfield LF, Lee J, Cunningham BB. A practical approach for the use of oral isotretinoin for infantile acne. Pediatr Dermatol 2005; 22:166.
- O'Connor NR, McLaughlin MR, Ham P. Newborn skin: Part I. Common rashes. Am Fam Physician 2008; 77:47.
- Humeau S, Bureau B, Litoux P, Stalder JF. Infantile acropustulosis in six immigrant children. Pediatr Dermatol 1995; 12:211.
- Mancini AJ, Frieden IJ, Paller AS. Infantile acropustulosis revisited: history of scabies and response to topical corticosteroids. Pediatr Dermatol 1998; 15:337.
- Good LM, Good TJ, High WA. Infantile acropustulosis in internationally adopted children. J Am Acad Dermatol 2011; 65:763.
- Jennings JL, Burrows WM. Infantile acropustulosis. J Am Acad Dermatol 1983; 9:733.
- Dromy R, Raz A, Metzker A. Infantile acropustulosis. Pediatr Dermatol 1991; 8:284.
- Van Praag MC, Van Rooij RW, Folkers E, et al. Diagnosis and treatment of pustular disorders in the neonate. Pediatr Dermatol 1997; 14:131.
- Vignon-Pennamen MD, Wallach D. Infantile acropustulosis. A clinicopathologic study of six cases. Arch Dermatol 1986; 122:1155.
- Bundino S, Zina AM, Ubertalli S. Infantile acropustulosis. Dermatologica 1982; 165:615.
- Kahn G, Rywlin AM. Acropustulosis of infancy. Arch Dermatol 1979; 115:831.
- Findlay RF, Odom RB. Infantile acropustulosis. Am J Dis Child 1983; 137:455.
- Feng E, Janniger CK. Miliaria. Cutis 1995; 55:213.
- Adam R, Schroten H. Picture of the month. Congenital sucking blisters. Arch Pediatr Adolesc Med 2007; 161:607.
- Levy R, Lam JM. Cutis marmorata telangiectatica congenita: a mimicker of a common disorder. CMAJ 2011; 183:E249.
- Cordova A. The Mongolian spot: a study of ethnic differences and a literature review. Clin Pediatr (Phila) 1981; 20:714.
- Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics 1976; 58:218.
- Leung AK. Mongolian spots in Chinese children. Int J Dermatol 1988; 27:106.
- Onayemi O, Adejuyigbe EA, Torimiro SE, et al. Prevalence of Mongolian spots in Nigerian children in Ile-Ife, Nigeria. Niger J Med 2001; 10:121.
- Gupta D, Thappa DM. Mongolian spots--a prospective study. Pediatr Dermatol 2013; 30:683.
- Goldenhersh MA, Savin RC, Barnhill RL, Stenn KS. Malignant blue nevus. Case report and literature review. J Am Acad Dermatol 1988; 19:712.
- Patel BC, Egan CA, Lucius RW, et al. Cutaneous malignant melanoma and oculodermal melanocytosis (nevus of Ota): report of a case and review of the literature. J Am Acad Dermatol 1998; 38:862.
- Hanson M, Lupski JR, Hicks J, Metry D. Association of dermal melanocytosis with lysosomal storage disease: clinical features and hypotheses regarding pathogenesis. Arch Dermatol 2003; 139:916.
- Ashrafi MR, Shabanian R, Mohammadi M, Kavusi S. Extensive Mongolian spots: a clinical sign merits special attention. Pediatr Neurol 2006; 34:143.
- Hackbart BA, Arita JH, Pinho RS, et al. Mongolian spots are not always a benign sign. J Pediatr 2013; 162:1070.
- Kurata S, Ohara Y, Itami S, et al. Mongolian spots associated with cleft lip. Br J Plast Surg 1989; 42:625.
- Halamek LP, Stevenson DK. Neonatal jaundice and liver disease. In: Neonatal-Perinatal Medicine, 7th ed, Fanaroff AA, Martin RJ (Eds), Mosby, St. Louis 2002. p.1309.
- Rubaltelli FF, Da Riol R, D'Amore ES, Jori G. The bronze baby syndrome: evidence of increased tissue concentration of copper porphyrins. Acta Paediatr 1996; 85:381.
- Eisen DB, Michael DJ. Sebaceous lesions and their associated syndromes: part I. J Am Acad Dermatol 2009; 61:549.
- Tanzi EL, Hornung RL, Silverberg NB. Halo scalp ring: a case series and review of the literature. Arch Pediatr Adolesc Med 2002; 156:188.
- Das S. Permanent baldness following caput succedaneum. J R Coll Gen Pract 1980; 30:428.
- Siegel DH, Holland K, Phillips RJ, et al. Erosive pustular dermatosis of the scalp after perinatal scalp injury. Pediatr Dermatol 2006; 23:533.
- SKIN LESIONS
- Benign vesiculopustular lesions
- - Erythema toxicum neonatorum
- - Transient neonatal pustular melanosis
- - Neonatal acne
- - Infantile acne
- - Infantile acropustulosis
- - Milia
- - Miliaria
- - Sucking blisters
- Vascular birthmarks
- Color changes
- - Cutis marmorata
- - Harlequin color change
- - Congenital dermal melanocytosis (Mongolian spot)
- - Bronze baby syndrome
- SCALP LESIONS
- Seborrheic dermatitis
- Nevus sebaceous of Jadassohn
- Aplasia cutis congenita
- Caput succedaneum
- - Halo scalp ring
- - Erosive pustular dermatosis of the scalp
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS