COMMON NEWBORN SKIN CONDITIONS
At birth, newborns experience many changes as they transition to life outside the womb. One of these changes may involve developing certain skin conditions. On the other hand, there are some skin lesions that are present even before birth. For caregivers, it’s important to determine if these conditions are either 1) benign and can be left alone or managed at home, 2) concerning and should be properly monitored with regular visits to the doctor, or 3) worrisome, needing an emergency consult.
Blood vessel birthmarks
Nevus simplex
Nevus simplex, also known as salmon patch, angel kiss or stork bite, are pink, flat skin lesions that usually have an irregular shape. These are common skin lesions, seen in around 30-40% of newborns. Nevus simplex may be seen on the forehead, eyelids, upper lip and neck, and are usually symmetrical. Most of the time, these marks fade after a few months. No specific treatment is necessary.
Port-wine stain
Port-wine stain, also known as capillary malformation or nevus flammeus, is caused by the dilation of small blood vessels found in the deeper part of the skin. These are pink to purple, flat, irregularly shaped skin lesions that are much larger than that of nevus simplex. These are commonly found on the head or neck. Unlike nevus simplex, port-wine stains affect only one side and are not symmetrical. This skin lesion may be present even during adulthood; it can develop a darker shade, become elevated, or cause minor bleeding episodes.
Some capillary malformations may be associated with disorders or conditions, such as Sturge-Weber syndrome, Klippel-Trenaunay syndrome and Beckwith-Wiedemann syndrome. This skin lesion is usually noted during a routine infant examination, but regular healthcare visits to monitor its progress may be done at the discretion of the healthcare provider.
Infantile hemangioma
Infantile hemangiomas, also known as strawberry marks, are red to bluish, palpable birthmarks that may look like tumors. Hemangiomas form due to excessive blood vessels in a certain area of the skin. These growths, found in 5% of infants, commonly develop at birth or within the first few weeks of life, and may further enlarge before decreasing in size. This type of hemangioma may grow at any area of the body, but these are commonly seen on the face, back, chest and scalp.
Infantile hemangiomas may be associated with or be the cause of other conditions, such as ulcerations, infections, or visual problems, depending on the location of the lesion. If the hemangioma is found on the face or eyes, has a beard-like shape, or is seen in a child with abnormal heart sounds, further evaluation should be done to rule out genetic or cardiac problems, as well as abnormalities in other body structures. Some hemangiomas may need treatment with propranolol or corticosteroids.
Pigmented birthmarks
Moles
Congenital melanocytic nevi are commonly known as moles. Like hemangiomas, these can be found at birth, or develop within the first year of life. Moles are likely due to excessive pigment-producing cells in the skin, called melanocytes. These growths, seen in around 3% of infants, are usually blue, brown, or black, flat or raised lesions that are commonly found on the chest, shoulders, upper back, upper arms and thighs.
Most small moles are benign. Large ones may signal a high risk for skin cancer. A child with multiple nevi may need to be seen by a healthcare provider to rule out any associated spinal cord disease. Moles may eventually become bigger as a child ages, but if this grows too quickly, an evaluation by a healthcare provider should be done.
Café-au-lait spots
Café-au-lait spots are flat, round or oval, tan or brown birthmarks that may vary in size, seen in 20-30% of children. Most of these lesions are seen at birth but may also develop as the child grows.
Although more often benign, these spots may be concerning if there are irregular shapes (such as asymmetry), multiple lesions, or if any are found in the armpits or groin areas. Associated conditions include neurofibromatosis, McCune-Albright syndrome, LEOPARD syndrome and Cowden syndrome.
Mongolian spots
Dermal melanocytosis, commonly referred to as Mongolian spots, are flat, blue to gray, slightly large skin lesions found at the back, buttocks, back of the thighs or the legs of newborns. These spots are more common in children with Asian, African-American and Hispanic ethnicity.
Mongolian spots usually fade on their own after a few years. Very few cases are associated with genetic conditions such as Niemann-Pick disease, mucolipidosis, gangliosidosis, Hurler syndrome or Hunter syndrome.
Transient skin color changes
Cutis marmorata
Cuts marmorata looks like a reddish or bluish, lacy or marbling discoloration over most of the body, particularly the trunk and extremities. This is often seen in the first few weeks of life and is triggered when the room or environment has is cold or has a low temperature. Although infants who are born term may develop cutis marmorata, it is more common in preterm infants. This condition gradually disappears as a child grows older.
If cutis marmorata does not resolve on its own, a proper medical evaluation may be needed to rule out associated conditions, such as hypothyroidism and congenital heart disease. Trisomy 18, Trisomy 21 and Cornelia de Lange syndrome are also associated with persistent cutis marmorata.
Harlequin color change
Harlequin color change is an intense redness covering one half of an infant’s body, sharply cut off at the middle of the body. This color change only lasts for up to 20 minutes at a time. This may occur within the first two months of life in nearly 10% of all newborns. Changing the newborn’s position can change the pattern of redness, as the color change is related to the pressure from their body position.
Harlequin syndrome is comprised of harlequin color change, paroxysmal flushing, and sweating. Consult with a healthcare provider may be done to rule out this condition.
Milia and Miliaria (heat rash)
Milia are tiny, pearly white cysts usually found around the face in newborn infants, especially the nose and chin areas. These usually form when the child’s pores are blocked. These are harmless and resolve on their own within the first month of life.
Like milia, miliaria form due to blockage, but of the sweat ducts instead of pores. There are two types of miliaria: small, multiple clear blisters (miliaria cristallina), and multiple, small rashes (miliaria rubra or prickly heat). Miliaria cristallina are commonly seen around the neck and trunk, while miliaria rubra are found on the forehead and upper trunk.
Miliaria may be avoided through preventive measures against overheating.
Pustular melanosis
Pustular melanosis is a condition characterized by skin lesions that has different forms: during the early phase, lesions look like pustules which may or may not rupture, while during the secondary or late phase, lesions are reddish, flat skin lesions. These lesions are more commonly seen in infants with African-American ethnicity. Affected areas may include the forehead, neck, upper chest, lower back, and thighs. This skin condition is usually seen at birth and may last as quick as a few days, or up to a few months.
Erythema toxicum
Erythema toxicum is one of the most common skin conditions in newborns, affecting 50-70% of term infants. During the first two days of life, affected infants can develop rashes with small, white to yellow raised bumps, usually seen on the face and trunk. These go away on their own after around one to two weeks and does not need any specific treatment.
If the rash is persistent beyond two weeks, consultation with an experienced healthcare provider, such as a pediatric dermatologist, should be done.
Cradle cap
Cradle cap is the common name for seborrheic dermatitis, a skin condition that looks worrisome but can be treated at home. An affected infant at around the first month of life may first develop redness of the scalp, which then leads to a thick, greasy, scaly, or crusty scalp that may extend to the face, neck and the back of the ears. If left untreated, it may even spread throughout the whole body.
Doctors may prescribe a topical medication if the scaling and crusting is severe. At home, one way to treat cradle cap is to frequently shampoo their hair, followed by soft brushing.
Diaper dermatitis
Diaper dermatitis is known as the most common skin disorder in infants. Constant exposure to rubbing and wiping of the buttocks, as well as delays in changing soiled diapers, can cause this condition. The rash is described as scaly, with bumps, fissures, or pus-filled lesions on areas in contact with the diaper.
Candida is a well-known cause of fungal infections, and has a unique type of cradle cap. The rash is beefy red, and some patches of skin outside the diaper area are also involved. In this case, consultation with a healthcare provider is warranted for proper antifungal treatment.
Jaundice
Jaundice is a condition wherein the skin turns yellow (or sometimes, orange) because of the accumulation of a substance in the body called bilirubin. The cause of jaundice is varied; it can be normal (physiologic) or due to a medical condition that must be treated promptly (pathologic).
The following are signs and symptoms that may point to a pathologic process that needs medical attention: jaundice that appears before the child turns 24 hours of age, jaundice that spreads too fast from the top to the bottom of the body, jaundice that is easily seen in an infant’s palms or soles, poor suck on nipple or bottle, or an excessively sleepy infant. If any of these are present, an emergency consult must be done immediately.
Summary
A wide variety of newborn skin conditions may be daunting, causing worry and anxiety for caregivers. Differentiating the benign lesions from the truly worrisome ones is one step to ensuring that infants are properly cared for and treated only when necessary.
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References:
- Kliegman, R.M. et al. (2020). Part 30 The Skin. Nelson Textbook of Pediatrics 21st edition. Elsevier.
- Kliegman, R.M. et al. (2020). Chapter 123 Digestive System Disorders. Nelson Textbook of Pediatrics 21st edition. Elsevier.
- O’Connor, N.R., McLaughlin, M.R., & Ham, P. (2008). Newborn Skin: Part I. Common Rashes. Am Fam Physician. 2008 Jan 1;77(1):47-52.
- O’Connor, N.R., McLaughlin, M.R., & Ham, P. (2008). Newborn Skin: Part II. Birthmarks. Am Fam Physician. 2008 Jan 1;77(1):56-60.
- Oakley, A. (2009). Skin conditions in newborn babies. DermNet New Zealand Trust. Taken from: https://dermnetnz.org/topics/skin-conditions-in-newborn-babies/
- Nguyen, N. & Maguiness, S.M. (2018). Baby Birthmarks & Rashes. American Academy of Pediatrics Section on Dermatology and Society for Pediatric Dermatology. Taken from: https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Your-Newborns-Skin-Birthmarks-and-Rashes.aspx
- Cradle Cap (2015). Caring for Your Baby and Young Child: Birth to Age 5, 6th Edition. American Academy of Pediatrics. Taken from: https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Cradle-Cap.aspx
- Kutlubay, Z. et al. (2017). Newborn Skin: Common Skin Problems. Maedica (Bucur). 2017 Jan; 12(1): 42–47.
