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HIGH-YIELD FACTS

  • Nevus flammeus, or port-wine stain, when present in the area innervated by the ophthalmic branch of the facial nerve, is associated with Sturge–Weber 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.

  • 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.

  • 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.

  • Multiple café-au-lait spots of neurofibromatosis increase the risk for auditory and central nervous system (CNS) tumors.

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

TERMINOLOGY OF PRIMARY LESIONS

  • Macules are nonpalpable lesions ≤1cm

  • Patches are nonpalpable lesions >1cm

  • Papules are palpable lesions ≤5mm

  • Plaques are palpable lesions >5mm

  • Nodules are palpable lesions, >5mm in both width and depth1

  • Telangiectasias are dilated superficial blood vessels

  • Vesicles are clear fluid-filled lesions, ≤5mm

  • Bullae are clear fluid-filled lesions, >5mm

  • Pustules are pus-filled lesions, ≤5mm

With the urgent need for adjustment to the extrauterine environment that the newborn faces, many different adaptive changes occur across all organ systems, including the skin. Skin lesions, or rashes, commonly occur, many of which are benign, but which usually are a cause of considerable concern for parents.

BENIGN NEONATAL SKIN LESIONS

Milia are tiny white-yellow discrete pearly papules, 1 to 2 mm, frequently occurring on the face and scalp. They are superficial inclusion cysts of the pilosebaceous units that contain laminated keratinized material of sebaceous origin.2 The lesions resolve spontaneously and no treatment is necessary.

Miliaria are lesions caused by obstruction of eccrine sweat gland ducts, especially in warm climates. Very superficial sweat gland obstruction results in miliaria crystallina, which results from sweat being trapped in the stratum corneum 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, caused when obstructed sweat leaks into the dermis, inciting an inflammatory response (Fig. 93-1).

Neonatal acne presents as open or closed comedones concentrated on the face and upper chest, thought to be related to excess maternal or exogenous androgens, ...

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