Section B: Childhood Dermatology

Normal Skin Changes

PATIENT STORY

A 2-week-old infant is brought to the office for her first well-baby check. The parents noticed a rash on the face. You diagnose the white spots on the bridge of the nose as milia and benign cephalic pustulosis (BCP) on the cheeks. The parents are happy to hear that BCP and milia will go away without treatment (Figures 114-1 and 114-2).

INTRODUCTION

• Rashes are common in newborns. Physicians will be consulted frequently, as they are a common parental concern. Most newborn rashes are benign; however, a few are associated with more serious conditions. A newborn's skin shows a variety of changes during the first 2 months of life, and most are self-limited. Physicians must be prepared to identify common rashes and advise parents.¹

• Milia are inclusion cysts that appear as tiny white papules in the skin (see Figure 114-1) or on the roof of the mouth.

• BCP is an acneiform eruption appearing as noncomedonal papules or pustules with surrounding erythema on the skin of newborns (see Figure 114-2). BCP accounts for the vast majority of diagnosed neonatal acne. True neonatal acne, though, encompasses comedonal and papulopustular lesions.

• Congenital dermal melanocytosis (CDM) is a hereditary, congenital patch of bluish-black or bluish-gray pigment usually in the sacral area, back, and buttocks of infants (Figures 114-3 and 114-4).

• Erythema toxicum neonatorum (ETN) is a benign, self-limited skin eruption appearing as small yellow-white papules or vesicles with surrounding skin erythema (Figures 114-5 and 114-6).