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Normal Skin Changes of Infancy

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Patient Story
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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 neonatal acne on the cheeks. The parents are happy to hear that the neonatal acne and milia will go away without treatment (Figures 92-1 and 92-2).

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FIGURE 92-1

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

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FIGURE 92-2

Neonatal acne on the same infant as in Figure 92-1. (Used with permission from Richard P. Usatine, MD.)

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Introduction
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  • Rashes are common in newborns. Physicians will be consulted frequently as they are a common parental concern. Almost all 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 provide advice to parents.1

  • Milia are inclusion cysts that appear as tiny white papules in the skin (Figure 92-1) or on the roof of the mouth.

  • Neonatal acne is an acneiform eruption appearing as small red papules or whiteheads with surrounding erythema on the skin of newborns (Figure 92-2).

  • A mongolian spot is a hereditary, congenital macule of bluish-black or bluish-gray pigment usually in the sacral area, back, and buttocks of infants (Figures 92-3 and 92-4).

  • Erythema toxicum neonatorum (ETN) is a benign, self-limited skin eruption appearing as small yellow-white papules or vesicles with surrounding skin erythema (Figures 92-5 and 92-6).

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FIGURE 92-3

Large mongolian spots covering the buttocks and back of a Hispanic infant. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 92-4

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

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FIGURE 92-5

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

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FIGURE 92-6

More widespread case of erythema toxicum neonatorum (ETN) covering the infant. ETN is completely benign and will resolve spontaneously. (Used with permission from the University of Texas Health Sciences Center, Division of Dermatology.)

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