Skin Diseases of the Neonates

Introduction

Rashes are the most common skin problem in neonates and can cause parents a great deal of anxiety. In addition, a newborn's skin may show multiple changes in the first four weeks. Although most are benign (non-cancerous) and self-limiting skin conditions, severe other skin infections may require additional workups.

What Kind of Skin Diseases Can a Neonate Have?

The common skin diseases among neonates include:

Transient Vascular Phenomena

A newborn's skin is deep red or purple with bluish hands and feet during the first hours of life. This bluish discoloration (acrocyanosis) fades away with the warming of the hands and feet or when the newborn stops crying.

Two types of transient skin changes are observed in neonates:

• Cutis Marmorata:

  • It is detected during the first two to four weeks of life due to physiological response to temperature changes.

  • It is clinically characterized by mottling of the skin involving the trunk and extremities.

  • It results from a vascular response to cold and often resolves when the skin is warmed.

  • It may persist for weeks to months.

  • No treatment is required.

• Harlequin Color Change:

  • Harlequin color change is seen in 10% of newborns and occurs when the newborns lie on their sides.

  • The color change persists for a few seconds to minutes and recurs in the first three weeks.

  • It is defined as erythema involving half of the newborn's body with simultaneous blanching of the other side with a sharp midline demarcation.

  • It is benign, and lesions fade away with crying or increased muscle activity.

Erythema Toxicum Neonatorum:

• It is a benign, self-limited skin condition occurring only during the newborn period, affecting 30% to 70% of newborns.

• Typically, lesions consist of red marks with papules (small bumps) on the face, trunk, and rest of the body, except the palms and soles.

• The etiology of this condition remains unknown. Lesions typically resolve over five to seven days but may recur for several weeks.

• No specific treatment is needed.

Transient Neonatal Pustular Melanosis:

• It is a benign and self-limited skin condition that occurs mainly in black newborns at birth.

• The eruptions appear on the forehead, neck, upper chest, sacrum, chest, and thighs which disappear within five days, leaving fine white collarettes of scale.

• They appear as small vesicles, superficial pustules (blisters), and pigmented macules (patches), which disappear within five days, with fine white collarettes of scale.

• No treatment is needed for this condition.

Neonatal Acne:

• Also known as baby acne or neonatal cephalic pustulosis, this is a common skin condition among newborns.

• Neonatal acne is benign and transient, occurring within the first 30 days of life.

• Neonatal acne results from the stimulation of sebaceous glands by maternal or infant androgens.

• It typically consists of closed comedones on the forehead, nose, and cheeks.

• Treatment is not recommended for neonate acne. It typically disappears within the first three months of life without medical intervention. However, neonates can be treated with a 2.5% Benzoyl Peroxide lotion when necessary in case of extensive lesions.

Milia:

• Milia are tiny white or yellow bumps caused by the retention of keratin within the dermis layer of the skin.

• The condition affects up to 50% of newborns.

• Milia occurs most often on the forehead, cheeks, nose, and chin but may appear on the upper trunk, limbs, penis, or mucous membranes.

• It typically resolves in the first few weeks of life, but sometimes it may persist into the second or third month and spread throughout the body.

• Treatment is not necessary as these lesions tend to resolve spontaneously.

Miliaria:

• Miliaria occurs due to blockage of the sweat duct.

• It affects up to 40% of infants and usually appears during the first month of life.

• Miliaria crystallina and miliaria rubra are the most common subtypes of miliaria.

• Miliaria crystallina is caused due to superficial eccrine duct closure, consisting of 1- to 2-mm vesicles without surrounding redness, most commonly seen on the head, neck, and trunk.

• Miliaria rubra (or heat rash) occurs due to a more profound level of sweat gland obstruction and appears as small red blisters and vesicles on covered portions of the skin.

• Both these subtypes of miliaria are benign. Minimizing overheating, removing excess clothing, cool baths or showers, and air conditioning help prevent these conditions.

Diaper Dermatitis (Diaper Rash):

• It includes all eruptions that occur in the area covered by the diaper.

• Several causes may macerate the skin, such as urine and feces, wiping, and rubbing. However, the most crucial factor is the wetness of the diaper area. Due to dampness, the skin's barrier function is destroyed, letting the irritants penetrate easily.

• It appears as a patch of inflamed, red skin on the buttocks.

• Diaper dermatitis is mostly self-limited that disappears within three days.

• Treatment involves using a barrier with minimal ingredients to avoid potential irritants or sensitizers. In addition, applying topical antifungal agents, mild corticosteroid creams, or petroleum jelly can speed healing.

Seborrheic Dermatitis (Cradle Crap):

• It is a common rash characterized by erythema and greasy scales.

• It occurs most commonly on the scalp but may include the face, ears, and neck.

• It often spreads to the diaper area, so it is essential to consider evaluating diaper dermatitis.

Mongolian Spots:

• These are blue-gray or brown spots on the skin of the buttocks, back, or legs.

• They appear in the first year of life and may resemble bruises but are painless.

• The spots emerge due to differences in skin color. They usually fade within a year.

Neonatal Pemphigus:

• It is a rare autoimmune blistering disease characterized by flaccid blisters on the skin and rarely in mucous membranes.

• The disease is caused by the placental transfer of maternal IgG autoantibodies to Desmoglein-3.

• It usually resolves in two to three weeks.

Conclusion

Skin problems are common in newborns and can be a source of parental concern. Most skin conditions are transient and do not require treatment; others may require additional workup. Seeing a dermatologist is essential to distinguish transient benign skin problems and severe diseases to diagnose and treat them early.