NEONATAL RASHES
CLASSIFICATIONS
• Transient
• Birthmarks
• Infections
• Infestations
• Geno-dermatosis
• neurocutaneous
VERNIX CASEOSA
• White, creamy, naturally occurring
biofilm covering the skin of the fetus
during last trimester of pregnancy.
• Composed of degenerated fetal
epidermis and sebaceous secretions.
• Functions: epidermal growth,
antimicrobial cover, thermal
regulation, anti-oxidant properties,
reflect intra uterine problems.
CUTIS MARMORATA
• Benign cutaneous vascular
phenomena seen in neonates as
physiologic vasomotor response
to cold.
• Reticulates, bluish mottling of
skin on trunk and extremities.
• Usually disappear as infant is
rewarmed.
• Persists in Down’s syndrome,
trisomy-18, hypothyroidism.
CUTIS MAMORATA TELANGIECTATICA CONGENITA
• Congenital,vascular,malformation present since
birth.
• Fixed patches of mottled skin with a marbled
or reticulate blue to pale purple patches.
• Doesn’t disappear after rewarming.
• Skin may appear indented due to dermal
atrophy.
• Localized or generalized
• Limbs are commonly affected.
• Congenital abnormalities associated-
craniofacial, neurological, vascular,
skeletal, hypothyroidism.
SUCKING BLISTERS
• A blister or denuded area seen in
neonates usually on forearm, wrist
and fingers due to vigorous sucking
in utero.
• One or two solitary clear bullous
lesion with no surrounding
erythema.
• Can also present as erosion or
crusted lesion.
• TX: topical antibiotic if eroded.
ACROCYANOSIS (PERIPHERAL CYANOSIS)
• Functional peripheral vascular
disorder characterized by bluish
discoloration of skin.
• Caused by vasospasm of small
vessels of skin in response to cold
• Resolves by warming the skin
• Recurrence unusual after 1 month
of age.
TOXIC ERYTHEMA OF NEWBORN
(ERYTHEMA TOXICUM NEONATORIUM)
• Benign, self limiting disorder of
unknown etiology.
• Most commonly, the eruption
initially takes the form of a blotchy,
macular erythema.
• Most commonly on trunk, face and
proximal part of limb.
• In severe cases, urticarial papules
arise within the erythematous area,
surrounded by pustules.
TRANSIET NEONATAL PUSTULAR
MELANOSIS
• Idiopathic pustular eruption that heals
with brown pigmented macules.
• Characterized by 1-3mm, flaccid ,
superficial, fragile pustules with no
surrounding erythema.
• Predominantly on the chin, forehead,
axilla and neck.
• Eventually pustules rupture and form
brown crust and finally small collarette of
scales.
• Pustular lesions resolves usually in 24-48
hours and hyperpigmented macules may
persists for 3 months.
ACROPUSTULOSIS OF INFANCY
• Unknown etiology
• Characterized by crops of pruritic, vesicopustular
lesions with predilection of palms and soles.
• Onset is usually in first 3 months of life but can present
at birth.
• Can also occur on dorsa of feet, hands, fingers, ankles
and forearms.
• Lesions appear as tiny red papules which evolves into
vesicles and then pustules within 24 hours.
• Each crop last for 7-14 days and tend to occur at 2-4
weeks intervals.
• Healing is succeeded by macular post inflammatory
hyper pigmentation
• TX: topical corticosteroids
MILIA
• Benign, keratinous cysts
• Small, firm, pearly-white papules, 1-
2mm in size predominantly occurring
on face of newborn babies
• Sites: cheeks, nose, nasolabial folds
and forehead.
• Usually disappear spontaneously
during first 3-4 weeks
• DD: Molluscum contagious-doesn’t
appear in immediate neonatal period,
sebacecous gland hyperplasia (yellow)
EPSTEIN PEARLS
• Yellowish white, keratinous cysts,
1-2mm diameter
• Along the alveolar ridges or in
midline at junction of hard and
soft palate.
• Generally disappear without
treatment within few weeks.
SEBACEOUS GLAND HYPERPLASIA
• Common benign proliferation of
the sebaceous glands seen during
first few weeks of life
• Results from maternal androgenic
stimulation of sebaceous gland.
• Multiple uniform, pinpoint
yellowish papules 1-3mm, most
prominent on the nose, cheeks,
upper lip and forehead.
• Resolves within few weeks.
MILIARIA
• Miliaria is a disorder due to blockage
of eccrine sweat ducts
• Subdivided into 3 subtypes:
1. Miliaria crystallina( stratum
corneum)
2. Miliaria rubra (mid-epidermal)
3. Miliaria profunda (dermal-
epidermal junctions)
• Predisposing factors: immature sweat
ducts, occlusive clothing, high heat
and humidity.
MILIARIA CRYSTALLINA
• Presents as crops of clear , thin walled,
superficial vesicles 1-2mm in diameter
without associated erythema
• Generally ruptures within 24hours
followed by brans-like desquamation
• Presence of intracorneal or sub
corneal vesicles in communication
with sweat ducts.
• Most frequently during first 2 weeks of
life on forehead, scalp, neck and upper
trunk.
MILIARIA RUBRA (PRICKLY HEAT)
• Erythematous papules and
papulovesicular about 1-4mm on
background of macular erythema
• Usually benign after second week of life
and predominates in trunk and
intertriginous areas where occlusion by
clothing is accentuated.
• Lesions can be itchy, sore or child
maybe restless and irritated.
• Miliaria profunda is rare in neonates.
Usually occurs in adults after repeated
episodes of miliaria rubra.
BIRTHMARKS (CONGENITAL NEVI)
• Birthmarks are congenital, benign
irregularity on the skin which is
present at birth or appears shortly
after birth.
• Represent an excess of one or more
of the normal components of skin
per unit area: blood vessels, lymph
vessels, pigment cells.
• Vascular birth marks are more
common.
SALMON PATCH
• Most common vascular birthmark of
infancy
• Area of superficially dilated
capillaries.
• Appears as irregular, dull pinkish red
macules with poorly defined
borders.
• Site: face (angel kiss) , nape of neck
(stork bite)
• More intense in color when baby is
crying.
PORT WINE STAIN (NAEVUS FLAMMEUS)
• Vascular birthmark
• Large, irregular deep red or
purple macule with well defined
border
• Represents a vascular
malformation involving mature
capillaries.
• Lesion persists throughout life
STRAWBERRY MARK (CAPILLARY
HAEMANGIOMA)
• Localized superficial hemangioma
• Develops during first few weeks of
life
• Start off as red macules and grow
rapidly during first four to five
months.
• Later appear as circumscribed oval
or round soft domed swelling of
intense scarlet red color.
• Site: head, neck or trunk
MONGOLIAN SPOTS
• Blue grey, poorly circumscribed
single or multiple macular lesions
• Entrapment of melanocytes in
dermis of developing embryo, the
cells fail to reach their proper
location in the epidermis.
• Usually presents at birth .
• Fade during first 2 years of life
• If persists- lasers or bleaching
creams
CONGENITAL MELANOCYTIC NEVI
• Benign proliferation of cutaneous melanocytes that
arises as a result of abnormal growth, development or
migration of melanocytes.
• Round or oval with smooth well defined borders and
surface texture can be papular, verrucous or cerebriform
• Initially light shaded and hairless but eventually become
more pigmented and acquire long hair.
• Lifetime risk of malignant transformation depend upon
size
• Naevi over spine or head have association with
neurocutaneous melanosis.
• TX: FULL THICKNESS EXCISION FOLLOWED BY
GRAFTING , CLOSE OBSERVATION , DERMABRASION,
CHENICAL PEEL AND LASERS
NEVUS OF OTA
• Extensive bluish patchy
unilateral melanocytotic lesion
that affects the sclera and the
skin adjacent to eyes distributed
along first and second branch of
trigeminal nerve.
• Mostly present at birth or
develop during first year of life .
APLASIA CUTIS CONGENITA
• Rare disorder characterized by focal absence
of epidermis, dermis and in some cases
subcutaneous tissues (bone and dura matter)
• Involves vertex of scalp
• Oval, marginated depressed hairless area
covered by wrinkled epithelial membrane or
appear as ulcer which heals by scar formation
• Ring of hair around defect (hair-collar sign)
• Can occur in other types of disorders (limb
abnormalities, epidermal nevi, embryologic
malformation, trisomy-13 , epidermolysis
bullosa)
BLUBERRY MUFFIN BABY
• Widespread purple erythematous oval or
circular macules or nodules reflecting
dermal erythropoiesis.
• Frank petechias on surface of some
lesions.
• Fades into light brown macules within
first few weeks of life
• This type of lesions seen in congenital
infections (TORCH), ABO & RH
incompatibility , neonatal LUPUS
ERTHEMATOUS.
NEONATAL ACNE
• Prepubertal acne can be divided
into 5 subgroups (neonatal,
infantile, mid childhood,
preadolescent and adolescent)
• Due to androgens(maternal&
infant)
• Present at or shortly after birth
with erythematous papulopustular
lesions and comedones
• Cheeks, chin and forehead.
NEONATAL CAPHALIC PUSTULOSIS
• Clinical similarity with neonatal acne
• Persists in first 3 weeks of life
• Association with Malassezia
• Cheeks, chin, neck, eyelids and upper
chest .
• Absence of comedones and presence
of pustules surrounding erythematous
halo helps differentiate with neonatal
acne.
• [Link] FUR IN PUSTULES CONTENT
• Self limiting, 2% ketoconazole cream
INTERTRIGO
• Superficial inflammatory
dermatosis involving body folds
and develops through friction
• Heat, moisture, friction and
sweat retention induce
maceration and inflammation.
• Secondarily infected by bacterial
and fungal infections.
DIAPER DERMATITIS (NAPKIN DERMATITIS)
• Acute inflammatory reaction of skin
associated with the wearing of napkins
• Irritant contact dermatitis due to occlusive
contact of urine and feces
• Rash is usually by the margins of napkins
with sparing of genital folds
• Papuloerosive eruption after prolonged
contact
• Secondary infections by candida is common
• Zinc cream or petroleum jelly .
• Mild topical steroids, anti fungal
SEBORRHEIC DERMATITIS (CRADLE CAP)
• Large flakes of yellowish scale on scalp
, may become matted into large
plague of crust
• Unknown etiology
• Site: scalp, face, postauricular, pre-
sternal.
• Begins with non eczematous ,
erythematous scaly dermatitis of scalp
• Topical steroids (mild)
• Baby shampoo, 2%ketoconazole
shampoo
