{"id":1527,"date":"2023-01-18T17:54:30","date_gmt":"2023-01-18T22:54:30","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/?post_type=chapter&p=1527"},"modified":"2023-01-26T18:06:31","modified_gmt":"2023-01-26T23:06:31","slug":"benign-skin-changes-in-the-newborn","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pedsdermprimer\/chapter\/benign-skin-changes-in-the-newborn\/","title":{"raw":"Benign Skin Changes of the Newborn","rendered":"Benign Skin Changes of the Newborn"},"content":{"raw":"

Erythema Toxicum Neonatorum<\/h1>\r\nErythema Toxicum Neonatorum (ETN) is a common benign skin disorder that occurs in nearly half of full-term neonates and usually appears in the first 3 days of life. It is less common in premature infants.\r\n
\r\n\r\nETN is usually not present at birth, but begins between 1-2 days of life. It presents with tiny papules, pustules or vesicles (1-2mm) with a blush of redness around them. They distributed mostly on the trunk, occasionally involving the face, buttocks and extremities. The palms and soles are almost never affected.\r\n\r\n<\/div>\r\n
\r\n\r\nNo management is required, as the rash is asymptomatic and resolves spontaneously. Alternate diagnoses should be considered if the rash is present immediately from birth, does not resolve with the expected time course, or the neonate is systemically unwell.\r\n\r\n \r\n\r\n<\/div>\r\n\r\n[caption id=\"attachment_385\" align=\"aligncenter\" width=\"300\"]\"\" Image 2.1: Erythema toxicum with tiny papules surrounded by a blush of erythema - Image credit to Dr. Joseph Lam[\/caption]\r\n

Transient Neonatal Pustular Melanosis<\/h1>\r\nTransient neonatal pustular melanosis<\/span> is usually present from birth and affects ~5% children with dark skin. It also presents with superficial pustules, however these are larger than those seen in ETN. When they resolve, they leave behind a collarette of scale and characteristic brown spots. As with ETN, it is a benign and self-resolving.<\/span>\r\n

Neonatal Cephalic Pustulosis<\/h1>\r\nNeonatal cephalic pustulosis<\/span>,<\/span> more commonly known as neonatal acne, is a pustular rash that usually starts between 2-3 weeks of life and resolves by ~3 months. It is distributed on the face but does not have comedones (\u201cblackheads\u201d and \u201cwhiteheads\u201d) like typical acne. It is thought caused by a reaction to <\/span>Malassezia<\/span> yeast. As the rash is self-limited, treatment is usually unnecessary.\u00a0<\/span>\r\n

Infantile Acne<\/h1>\r\nInfantile acne<\/span> is a form of acne that occurs slightly later than this (between 2-12 months of age) and differs in that there are frequently comedones in addition to pustules. It can result in scarring so treatments similar to those for adolescent acne are recommended (similar approach to adolescent acne). If severe, evaluation for precocious puberty is recommended.\u00a0\u00a0<\/span>\r\n\r\n \r\n\r\n[caption id=\"attachment_375\" align=\"aligncenter\" width=\"300\"]\"\" Image 2.2: Neonatal acne with inflammatory papules and pustules but no comedones[\/caption]\r\n

Neonatal Candidiasis<\/span><\/span><\/h1>\r\nNeonatal candidiasis<\/span><\/span> is a y<\/span>east infection of the skin<\/span> acquired during or shortly after delivery. It usually presents around 1 week of age<\/span> and <\/span>affects the diaper area, but may also be seen in body folds and on the face. It consists of red patches with satellite papules and pustules.<\/span> T<\/span>opical antifungals are usually <\/span>sufficient.<\/span> Less commonly, <\/span>the <\/span>infection<\/span> is<\/span> acquire<\/span>d<\/span> <\/span>in utero<\/span><\/span> and is<\/span> present <\/span>at birth<\/span> (<\/span><\/span>congenital candidiasis<\/span><\/span>)<\/span>.\u00a0<\/span> This rash is<\/span> more widespread and<\/span> premature <\/span>or unwell <\/span>neonates <\/span>may require<\/span> IV antifungals due to a risk of systemic infection.<\/span><\/span>\u00a0<\/span>\r\n\r\n \r\n\r\n[caption id=\"attachment_376\" align=\"aligncenter\" width=\"300\"]\"\" Image 1.3: Ch.2: Congenital candidiasis with tiny erythematous pustules and papules[\/caption]\r\n

Miliaria<\/span><\/span><\/h1>\r\nMiliaria<\/span><\/span> affects<\/span> ~15% of newborns. It occurs due to obstruction of sweat ducts and may present as small \u201c<\/span>dew drop-like<\/span>\u201d<\/span> vesicles<\/span>, pustules or red bumps depending on the dept<\/span>h<\/span> of blockage.<\/span> It commonly occurs on the head, neck and upper trunk and may follow occlusion and\/or sweating (such as excess warming in an incubator or tight swaddling). <\/span>It resolves without treatment.<\/span><\/span>\u00a0<\/span>\r\n
\r\n

Cutis Marmorata<\/h1>\r\nCutis marmorata is a normal physiologic skin change seen in ~50% of newborns, and occasionally lasting until later in life. It is caused by changes in the tone of superficial vessels in response to the ambient temperature. It presents with a mottled (lacy or net-like) blue to red discolouration that occurs when the body is exposed to cold temperatures. The rash usually fades away when the body is rewarmed. It is important to distinguish it from cutis marmorata telangiectatica congenita (CMTC), a vascular anomaly. CMTC differs from cutis marmorata in that it does not typically fade with rewarming, may be localized and may have atrophy of the affected area.\r\n\r\n \r\n\r\n<\/div>\r\n\r\n[caption id=\"attachment_387\" align=\"aligncenter\" width=\"234\"]\"\" Image 2.4: Reticulate violaceous plaque with atrophy in CTMC
- Image credit to Dr. Joseph Lam[\/caption]","rendered":"

Erythema Toxicum Neonatorum<\/h1>\n

Erythema Toxicum Neonatorum (ETN) is a common benign skin disorder that occurs in nearly half of full-term neonates and usually appears in the first 3 days of life. It is less common in premature infants.<\/p>\n

\n

ETN is usually not present at birth, but begins between 1-2 days of life. It presents with tiny papules, pustules or vesicles (1-2mm) with a blush of redness around them. They distributed mostly on the trunk, occasionally involving the face, buttocks and extremities. The palms and soles are almost never affected.<\/p>\n<\/div>\n

\n

No management is required, as the rash is asymptomatic and resolves spontaneously. Alternate diagnoses should be considered if the rash is present immediately from birth, does not resolve with the expected time course, or the neonate is systemically unwell.<\/p>\n

 <\/p>\n<\/div>\n

\"\"
Image 2.1: Erythema toxicum with tiny papules surrounded by a blush of erythema – Image credit to Dr. Joseph Lam<\/figcaption><\/figure>\n

Transient Neonatal Pustular Melanosis<\/h1>\n

Transient neonatal pustular melanosis<\/span> is usually present from birth and affects ~5% children with dark skin. It also presents with superficial pustules, however these are larger than those seen in ETN. When they resolve, they leave behind a collarette of scale and characteristic brown spots. As with ETN, it is a benign and self-resolving.<\/span><\/p>\n

Neonatal Cephalic Pustulosis<\/h1>\n

Neonatal cephalic pustulosis<\/span>,<\/span> more commonly known as neonatal acne, is a pustular rash that usually starts between 2-3 weeks of life and resolves by ~3 months. It is distributed on the face but does not have comedones (\u201cblackheads\u201d and \u201cwhiteheads\u201d) like typical acne. It is thought caused by a reaction to <\/span>Malassezia<\/span> yeast. As the rash is self-limited, treatment is usually unnecessary.\u00a0<\/span><\/p>\n

Infantile Acne<\/h1>\n

Infantile acne<\/span> is a form of acne that occurs slightly later than this (between 2-12 months of age) and differs in that there are frequently comedones in addition to pustules. It can result in scarring so treatments similar to those for adolescent acne are recommended (similar approach to adolescent acne). If severe, evaluation for precocious puberty is recommended.\u00a0\u00a0<\/span><\/p>\n

 <\/p>\n

\"\"
Image 2.2: Neonatal acne with inflammatory papules and pustules but no comedones<\/figcaption><\/figure>\n

Neonatal Candidiasis<\/span><\/span><\/h1>\n

Neonatal candidiasis<\/span><\/span> is a y<\/span>east infection of the skin<\/span> acquired during or shortly after delivery. It usually presents around 1 week of age<\/span> and <\/span>affects the diaper area, but may also be seen in body folds and on the face. It consists of red patches with satellite papules and pustules.<\/span> T<\/span>opical antifungals are usually <\/span>sufficient.<\/span> Less commonly, <\/span>the <\/span>infection<\/span> is<\/span> acquire<\/span>d<\/span> <\/span>in utero<\/span><\/span> and is<\/span> present <\/span>at birth<\/span> (<\/span><\/span>congenital candidiasis<\/span><\/span>)<\/span>.\u00a0<\/span> This rash is<\/span> more widespread and<\/span> premature <\/span>or unwell <\/span>neonates <\/span>may require<\/span> IV antifungals due to a risk of systemic infection.<\/span><\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

\"\"
Image 1.3: Ch.2: Congenital candidiasis with tiny erythematous pustules and papules<\/figcaption><\/figure>\n

Miliaria<\/span><\/span><\/h1>\n

Miliaria<\/span><\/span> affects<\/span> ~15% of newborns. It occurs due to obstruction of sweat ducts and may present as small \u201c<\/span>dew drop-like<\/span>\u201d<\/span> vesicles<\/span>, pustules or red bumps depending on the dept<\/span>h<\/span> of blockage.<\/span> It commonly occurs on the head, neck and upper trunk and may follow occlusion and\/or sweating (such as excess warming in an incubator or tight swaddling). <\/span>It resolves without treatment.<\/span><\/span>\u00a0<\/span><\/p>\n

\n

Cutis Marmorata<\/h1>\n

Cutis marmorata is a normal physiologic skin change seen in ~50% of newborns, and occasionally lasting until later in life. It is caused by changes in the tone of superficial vessels in response to the ambient temperature. It presents with a mottled (lacy or net-like) blue to red discolouration that occurs when the body is exposed to cold temperatures. The rash usually fades away when the body is rewarmed. It is important to distinguish it from cutis marmorata telangiectatica congenita (CMTC), a vascular anomaly. CMTC differs from cutis marmorata in that it does not typically fade with rewarming, may be localized and may have atrophy of the affected area.<\/p>\n

 <\/p>\n<\/div>\n

\"\"
Image 2.4: Reticulate violaceous plaque with atrophy in CTMC
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