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Erythema toxicum

Erythematous macules, papules, pustules, vesicles, or wheals on the face, torso, proximal limbs, and buttocks

Spares palms and soles

24–48 h after birth, may be seen ≤2 wk of age

Resolve spontaneously and heal without sequelae


Affects 50% of full-term neonates

Eosinophils on Wright's stain of pustules

Transient neonatal pustular melanosis

Fragile, superficial pustules; no erythema

After rupture → collarette of scale and hyperpigmentation

Widespread, including the palms and soles

Present at birth

Hyperpigmentation may last several months


Affects darker-skinned, full-term neonates

Sterile subcorneal neutrophilic pustules

Miliaria crystalline

Small, flaccid vesicles on the forehead, neck, upper trunk, and occluded areas

Sometimes present at birth

Avoid overheating and overswaddling

Caused by obstruction of eccrine sweat ducts near the surface of the skin

Miliaria rubra

Small erythematous papules and pustules on the forehead, neck, upper trunk, and occluded areas

Usually after first wk of life

Avoid overheating and overswaddling

Caused by obstruction of eccrine sweat ducts in the deeper layer of the epidermis


1- to 2-mm white or yellow epidermoid cysts usually on the face

Usually resolve by age 1 mo


If seen on palate, known as Epstein's Pearls.

Neonatal cephalic pustulosis (neonatal acne)

Discrete, noncomedonal papules or pustules on an erythematous base

Usually on the cheeks; also on the forehead, chin, eyelids, neck, upper chest, and scalp

Onset during first 2–3 wk of life; spontaneously resolves within weeks

None necessary; may be improved with topical clotrimazole

May be caused by Malassezia spp.

Acropustulosis of infancy

Crops of acral, pruritic vesicles and pustules on the hands, wrists, feet, and ankles

May present in the neonatal period but usually at 3–6 mo of age

Last 1–2 wk and recur in 3–4 wk

Less frequent relapses with age; complete resolution usually by age 3 yr

Topical corticosteroids or oral antihistamines

If severe, consider dapsone

Some pts respond to oral erythromycin

Must exclude scabies (burrows, genital involvement); microscopic exam of scraping

Nevus sebaceous

Hairless, thin, orange plaque on the scalp or face; may be seen on the neck or trunk

Progressive thickening and a verrucous appearance

Observation; complete excision for cosmesis

<1% develop secondary basal cell carcinoma

Congenital melanocytic nevus

Tan or brown, oval plaques; sometimes hairy

Commensurate growth with age; occasionally regress

May become verrucous with pigment changes

Yearly skin check for changes

Consider bx and excision based on clinical changes, melanoma risk, location, age, and FH

Giant nevi with greater risk of melanoma progression

Neurocutaneous melanocytosis with some larger scalp or axial lesions

Nevus simplex or macular (vascular) stain (salmon patch, angel kiss, stork bite)

Salmon pink, vascular patch commonly on the forehead, upper eyelids, or nape of the neck

May become more prominent with crying; blanches with pressure

Most fade or resolve spontaneously, but neck lesions usually persist

None necessary; pulsed-dye laser for cosmesis

Mongolian spot (dermal melanocytosis)

Bluish patches often on the lumbosacral or buttock areas

Seen more commonly ...

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