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 | None | 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 | None | 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 |
Milia | 1- to 2-mm white or yellow epidermoid cysts usually on the face | Usually resolve by age 1 mo | None | 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 ... |