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High-Yield Facts

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  • Nevus flammeus, or Port-wine stains, when present in the area innervated by the ophthalmic branch of the facial nerve is associated with Sturge–Webber syndrome, a neurocutaneous disorder with vascular malformations of the brain and intractable seizures.

  • Multiple or clustered capillary hemangiomas may be associated with deep tissue and parenchymal involvement and further evaluation is necessary.

  • Candida skin or oral infections may be secondary to excessive use of oral antibiotics. Treatment includes antifungal agents such as nystatin, ketoconazole, or clotrimazole as well as consideration of probiotics and hygiene.

  • Dermal melanosis or Mongolian spots are dark blue–grey patches of melanocytes located in the dermis. Mongolian spots should not be confused with bruising.

  • Seborrheic dermatitis can be recognized clinically by the presence of greasy scales and erythematous plaques.

  • Diaper dermatitis is usually caused by irritation of the skin from prolonged contact with feces and urine. Sparing of the skin folds is diagnostic.

  • Multiple café au lait spots of neurofibromatosis increase the risk for auditory and CNS tumors.

  • Vascular malformations in a “beard distribution” on the face are associated with airway hemangiomas.

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There is a tremendous burden on the newborn infant to abruptly adapt to the new extrauterine environment. Many changes occur, including those within the skin and dermal systems. Benign and transient rashes commonly occur and often cause significant parental concern.

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Milia are 1 to 2 mm, discreet pearly papules usually limited to the face and scalp. They are superficial inclusion cysts that contain laminated keratinized material of sebaceous origin.1 No treatment is necessary, and the lesions resolve spontaneously.

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Miliaria are lesions caused by obstruction of eccrine sweat glands, and are particularly common in warm climates. Very superficial sweat gland obstruction results in miliaria crystallina which results from sweat being trapped in the intracorneal layer of the skin producing tiny clear vesicles. Miliaria rubra or heat rash is common in febrile or overheated infants. These are erythematous small papules that are most commonly found on the upper trunk and head. Neonatal acne would present as open or closed comedones concentrated to the face and upper chest which is thought to be related to excess maternal or exogenous androgen and self-limiting.

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Erythema toxicum is present in up to 50% of newborn infants. The lesions usually appear by the second day of life, last approximately 1 week, and resolve spontaneously. The rash presents as pinpoint, papulopustular lesions on an erythematous base that appear on the face, trunk, and extremities. The lesions are at the opening of sebaceous ducts. Characteristic findings with Wright stain will reveal collections of eosinophils with absence of infectious organisms.1

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Pustular melanosis is found almost exclusively in African American infants, and the lesions are usually present at birth. It presents with a combination of fine pustules, areas of fine scale, and hyperpigmented macules where prior pustules were located.1 A Wright stain of the ...

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