Newborn Skin Exam

Aka: Newborn Skin Exam, Newborn Skin Conditions, Dermatologic Conditions in Infants, Newborn Rash, Dermatitis in Infants

1. See Also
   1. Neonatal Pustules and Vessicles
   2. Newborn Exam
   3. Common Pediatric Skin Rashes
2. Findings: Normal - Transient (resolves in minutes to hours)
   1. Miliaria (Heat Rash)
   2. Petechiae
      1. Scalp and face after vertex delivery
   3. Vernix Caseosa
      1. Cheesy white skin covering present at birth
   4. Transient vascular phenomena
      1. Cutis Marmorata (skin mottling related to cold exposure)
      2. Harlequin Color Change (positional erythema on the dependent side of the body)
3. Findings: Normal - Short-term (resolves in days to months)
   1. Erythema Toxicum Neonatorum
      1. Yellow Papules (eos) on red base affected face and trunk, disappearing within days to a week
      2. Differentiate from Neonatal HSV
   2. Neonatal Pustular Melanosis
      1. Milky fluid filled Vesicles without erythema, <5 mm on torso, buttock, forehead, chin
      2. Pigmented Macule with scale after Vesicle ruptures and may persist for months
   3. Milia
      1. Pinpoint white, keratin-filled Papules (blocked Sebaceous Glands) on nose and cheeks
      2. Spontaneously rupture and resolve within the first few weeks of life
   4. Sucking Blister
      1. Develops from infant sucking on skin
   5. Lanugo
      1. Fine hair on Shoulders and back
   6. Spontaneous Fat Necrosis
   7. Acne Neonatorum
4. Findings: Normal - Birthmarks, Long-term (Persists for months to years - some do not resolve)
   1. See abnormal or risk-associated Birthmarks below (e.g. Congenital Melanocytic Nevi)
   2. Mongolian Spots (Dermal Melanosis)
      1. Large (up to 10 cm) bluish-gray pigment patches on extremities as well as lumbar, sacral and buttock region
      2. Occurs with darker skin (black, hispanic and native american)
   3. Nevus Simplex (Salmon Patch)
      1. Macular pink to red capillary dilations that fade with time, occurring on upper Eyelids, forehead, nape of neck (Stork bite)
   4. Hemangioma
      1. Benign vascular lesions
      2. May result in focal obstruction (esp. airway Hemangioma)
5. Findings: Important Infections
   1. Neonatal Herpes Simplex Virus
      1. Vesicular Lesions in infant born to mother with HSV
      2. Emergent IV Acyclovir is critical
   2. Congenital Syphilis
      1. Lesions on palms and soles
   3. Neonatal Scabies
      1. Infants have more severe, diffuse cases that may result in Failure to Thrive
   4. Staphylococcal Scalded Skin Syndrome
   5. Impetigo
6. Findings: Abnormal or lesions that require evaluation, specific management or observation
   1. Pallor
      1. Anemia
   2. Jaundice onset within first day of life
      1. See Hemolytic Disease of the Newborn
      2. See Neonatal Jaundice
   3. Cyanosis
      1. See Cyanosis in Infants
   4. Mottling
      1. Consider Sepsis, Hypothermia
      2. Distinguish from the normal Cutis Marmorata
   5. Gray Skin Coloration
      1. Acidosis (Inborn Errors of Metabolism)
   6. Skin findings suggestive of occult spinal cord lesion
      1. See Cutaneous Signs of Dysraphism
   7. Vesicles
      1. Consider Neonatal HSV
      2. Distinguish from Erythema Toxicum Neonatorum
   8. Bullae
      1. Consider Bullous Impetigo
   9. Aplasia Cutis Congenita
      1. May be associated with skull deformities
   10. Nevus Flammeus (port wine stain)
       1. Dark purple or red capillary malformation that does not typically fade
       2. Refer to ophthalmology if involvement near the eye
       3. May be associated with Sturge-Weber Syndrome (trigeminal region) or Klippel-Trenaunay-Weber Sydrome (extremity)
   11. Nevus Sebaceus
       1. Yellow hairless Plaque on scalp or face
       2. May be associated with epidermal nevus syndrome and carries risk of future skin cancer in 10-15% of cases
   12. Smooth Muscle Hamartoma
       1. Hyperpigmentation and Hypertrichosis overlies a firm nodular base
   13. Congenital Melanocytic Nevi
       1. See Congenital Melanocytic Nevi
   14. Cafe-Au-Lait Macule
       1. "Coffee with milk" (tan to brown) colored flat Macule, <4 cm in infants and up to 30 cm in adults, usually located on trunk
       2. Six of more lesions (>5 mm prepubertal, >15 mm postpubertal) are associated with Neurofibromatosis, Tuberous Sclerosis, Albright Syndrome
7. References
   1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
   2. O'Connor (2008) Am Fam Physician 77(1): 47-52 [PubMed]