Chapter 89

• 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.

When the newly born infant leaves the protection of the intrauterine fluid environment, the skin and its complex organs must adapt quickly to the continually changing environment of the real world. As sebaceous and sweat glands in the skin adapt to the changes, transient and benign rashes commonly appear.1 Although clinically insignificant, these rashes cause high anxiety in young, new parents.

Milia are small, discreet white papules usually limited to the face and scalp. They are small inclusion cysts that arise from sebaceous glands at the base of hair follicles. Milia consist of keratinized debris. No treatment is necessary, and the lesions resolve spontaneously in weeks to months.

Miliaria are lesions caused by obstruction of eccrine sweat glands. These 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.

Erythema toxicum is present in up to 50% of newborn infants. They usually appear shortly after discharge from the hospital at 24 to 48 hours and last approximately 1 week. These are pinpoint, papulopustular lesions on an erythematous base that appear on the face, trunk, and extremities. The lesions are at the opening of sebaceous ducts. A scraping performed with Wright stain will reveal sheets of eosinophils.

Pustular melanosis is found almost exclusively in African American infants, and the lesions are usually present at birth. These are very superficial pustules that become scaly brown macules as they resolve. A Wright stain of the contents will show a predominance of neutrophils. If necessary, they can be differentiated from neonatal pyoderma by the absence of bacteria on Gram stain. As they resolve, the subcorneal pustules may persist as hyperpigmented small brown macules for months. There are a variety of vesiculopustular lesions that can be confused with pustular melanosis that may have serious complications (Table 89–1)2.

Table 89-1. Vesiculopustular and Bullous Lesions with Systemic Complications2

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