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Normal Skin Changes

PATIENT STORY

A 2-week-old infant is brought to the office for her first well-baby check. The parents noticed a rash on the face. You diagnose the white spots on the bridge of the nose as milia and benign cephalic pustulosis (BCP) on the cheeks. The parents are happy to hear that BCP and milia will go away without treatment (Figures 114-1 and 114-2).

FIGURE 114-1

Milia on the face of a 2-week-old infant with greatest number of milia on the nose. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 114-2

Benign cephalic pustulosis on the same infant. (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

  • Rashes are common in newborns. Physicians will be consulted frequently, as they are a common parental concern. Most newborn rashes are benign; however, a few are associated with more serious conditions. A newborn's skin shows a variety of changes during the first 2 months of life, and most are self-limited. Physicians must be prepared to identify common rashes and advise parents.1

  • Milia are inclusion cysts that appear as tiny white papules in the skin (see Figure 114-1) or on the roof of the mouth.

  • BCP is an acneiform eruption appearing as noncomedonal papules or pustules with surrounding erythema on the skin of newborns (see Figure 114-2). BCP accounts for the vast majority of diagnosed neonatal acne. True neonatal acne, though, encompasses comedonal and papulopustular lesions.

  • Congenital dermal melanocytosis (CDM) is a hereditary, congenital patch of bluish-black or bluish-gray pigment usually in the sacral area, back, and buttocks of infants (Figures 114-3 and 114-4).

  • Erythema toxicum neonatorum (ETN) is a benign, self-limited skin eruption appearing as small yellow-white papules or vesicles with surrounding skin erythema (Figures 114-5 and 114-6).

FIGURE 114-3

Congenital dermal melanocytosis (mongolian spots) covering the buttocks and back of a Hispanic infant. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 114-4

Congenital dermal melanocytosis (mongolian spots) on the back of a 1-year-old black child. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 114-5

One small spot of erythema toxicum neonatorum on a 2-day-old infant. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 114-6

More widespread case of erythema toxicum neonatorum covering the infant. ETN is completely benign and will resolve spontaneously. (Reproduced with permission from Richard P. Usatine, MD.)

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