Skin disorders are one of the most common problems in pediatrics. Never underestimate parental concerns about their child’s skin. Unlike many disease processes, the skin is visible and noticeable to parents and others. Examination of the skin requires observation and palpation of the entire skin surface under good light. Do not forget to look at the eyes and mouth for mucous membrane involvement. Examination should include onset, duration, and inspection of a primary lesion. It is also important to note secondary changes, morphology, and distribution of the lesions.
Neonatal Dermatoses
1. Cutis Marmorata
![]()
![]()
3. Transient Neonatal Pustular Melanosis![]()
![]()
![]()
![]()
![]()
8. Subcutaneous Fat Necrosis![]()
Neonatal Dermatoses
1. Cutis Marmorata
- Transient, blanchable, reticulated mottling occurs on the skin exposed to a cool environment.
- No treatment is necessary; the condition generally resolves by 1 year of age.
- If it persists, consider hypothyroidism, heart disease, or other associated abnormalities.
3. Transient Neonatal Pustular Melanosis
- Pustular lesions rupture easily and leave hyperpigmented macules on the neck, chin, forehead, lower back, and shins .
- Almost always present at birth, this condition is more common in dark-skinned infants.
- It is self-limited. Pustules resolve within days, but hyperpigmentation may take months to resolve.
- Comedones, pustules, and papules on the face resemble acne vulgaris .
- Generally develops at 2–3 weeks of age and resolves within 6 months.
- No treatment is usually necessary; wash face with baby soap. In severe cases, referral to a pediatric dermatologist may be warranted.
- These 1–2 mm pearly white papules are found most commonly on the face but may occur anywhere. On the palate, they are known as “Epstein pearls.”
- They may be present at birth.
- They usually resolve without treatment by 2–6 months of age.
- This sweat retention as a result of plugging of sweat glands is worsened by heat and humidity.
- Miliaria crystallina are 1–2 mm vesicles without erythema in intertriginous areas, neck, and chest.
- Miliaria rubra are erythematous papules in the same distribution that result from obstruction deeper in the epidermis.
- This condition resolves without treatment in a dry environment.
- This transient erythematous flush occurs on the dependent half of the body when the infant is placed on his or her side.
- This self-limited condition generally resolves within minutes but may recur.
8. Subcutaneous Fat Necrosis
- Erythematous subcutaneous nodules and plaques may be fluctuant.
- They appear at 1–6 weeks of life and generally resolve without treatment in 2–6 months. Fluctuant nodules require drainage.
- They may be associated with significant hypercalcemia as well as localized calcification, so infants should be monitored for hypercalcemia for at least 6 months after appearance of extensive lesions.