II. Findings: Normal - Transient (resolves in minutes to hours)
- Miliaria (Heat Rash)
-
Petechiae
- Scalp and face after vertex delivery
- Vernix Caseosa
- Cheesy white skin covering present at birth
- Transient vascular phenomena
- Cutis Marmorata (skin mottling related to cold exposure)
- Harlequin Color Change (positional erythema on the dependent side of the body)
III. Findings: Normal - Short-term (resolves in days to months)
-
Erythema Toxicum Neonatorum
- Yellow Papules (eos) on red base affected face and trunk, disappearing within days to a week
- Differentiate from Neonatal HSV
- Neonatal Pustular Melanosis
-
Milia
- Pinpoint white, keratin-filled Papules (blocked Sebaceous Glands) on nose and cheeks
- Spontaneously rupture and resolve within the first few weeks of life
- Sucking Blister
- Develops from infant sucking on skin
- Lanugo
- Fine hair on Shoulders and back
- Spontaneous Fat Necrosis
- Acne Neonatorum
IV. Findings: Normal - Birthmarks, Long-term (Persists for months to years - some do not resolve)
- See abnormal or risk-associated Birthmarks below (e.g. Congenital Melanocytic Nevi)
-
Mongolian Spots (Dermal Melanosis)
- Large (up to 10 cm) bluish-gray pigment patches on extremities as well as lumbar, sacral and buttock region
- Occurs with darker skin (black, hispanic and native american)
-
Nevus Simplex (Salmon Patch)
- Macular pink to red capillary dilations that fade with time, occurring on upper Eyelids, forehead, nape of neck (Stork bite)
-
Hemangioma
- Benign vascular lesions
- May result in focal obstruction (esp. airway Hemangioma)
V. Findings: Important Infections
-
Neonatal Herpes Simplex Virus
- Vesicular Lesions in infant born to mother with HSV
- Emergent IV Acyclovir is critical
-
Congenital Syphilis
- Lesions on palms and soles
- Neonatal Scabies
- Infants have more severe, diffuse cases that may result in Failure to Thrive
- Staphylococcal Scalded Skin Syndrome
- Impetigo
VI. Findings: Abnormal or lesions that require evaluation, specific management or observation
- Pallor
- Jaundice onset within first day of life
- Cyanosis
- Mottling
- Consider Sepsis, Hypothermia
- Distinguish from the normal Cutis Marmorata
- Gray Skin Coloration
- Acidosis (Inborn Errors of Metabolism)
- Skin findings suggestive of occult spinal cord lesion
-
Vesicles
- Consider Neonatal HSV
- Distinguish from Erythema Toxicum Neonatorum
-
Bullae
- Consider Bullous Impetigo
-
Aplasia Cutis Congenita
- May be associated with skull deformities
-
Nevus Flammeus (port wine stain)
- Dark purple or red capillary malformation that does not typically fade
- Refer to ophthalmology if involvement near the eye
- May be associated with Sturge-Weber Syndrome (trigeminal region) or Klippel-Trenaunay-Weber Sydrome (extremity)
-
Nevus Sebaceus
- Yellow hairless Plaque on scalp or face
- May be associated with epidermal nevus syndrome and carries risk of future Skin Cancer in 10-15% of cases
-
Smooth Muscle Hamartoma
- Hyperpigmentation and Hypertrichosis overlies a firm nodular base
- Congenital Melanocytic Nevi
-
Cafe-Au-Lait Macule
- "Coffee with milk" (tan to brown) colored flat Macule, <4 cm in infants and up to 30 cm in adults, usually located on trunk
- Six of more lesions (>5 mm prepubertal, >15 mm postpubertal) are associated with Neurofibromatosis, Tuberous Sclerosis, Albright Syndrome
VII. References
- Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
- O'Connor (2008) Am Fam Physician 77(1): 47-52 [PubMed]