That Brand New Baby Skin

Newborns often present with skin findings, many of which are benign. In general, our approach to these patients depends on various factors:

  • Sick versus not sick
  • Prenatal risk factors
  • Vital signs
  • Exam findings apart from the skin

Harlequin Color Change

Cutis marmorata

Erythema Toxicum Neonatorum

Transient Neonatal Pustular Melanosis

  • Appearance: vesiculopustular rash affecting all bodily areas; lesions lack surrounding erythema; lesions rupture easily, leaving behind a hyperpigmented macule
  • Fades over 3-4 weeks
  • Board pearl: lesions contain PMNs
  • Examples:

Neonatal cephalic pustulosis

  • Previously called acne neonatorum, which is a misnomer because there is no stimulation of sebaceous glands and no comedones
  • Appearance: pustular eruption arising on the face/scalp, usually in the 3rd week of life
  • Mechanism: likely a reaction to Malassezia
    • In contrast, infantile acne appears to result from androgenic stimulation of sebaceous glands, leading to the appearance of comedones around 2-4 months of life
  • Examples:


  • Very common finding, affecting around half of newborns
  • Appearance: pearly white or yellow papules
  • Mechanism: retention of keratin
  • Usually spontaneously regress within the first month
  • May occur on the hard palate (Bohn’s nodules) or gum margins (Epstein’s pearls)
  • Examples:


Seborrheic Dermatitis

PIGMENTED Birthmarks

Congenital Melanocytic Nevi

Dermal Melanosis

Vascular Birthmarks


  • Less common, affecting 1-2% of newborns
  • May develop anytime in first few months of life, but tend to involute/disappear after infancy
  • Most often cosmetically bothersome, but may be clinically concerning depending on size and location
    • Scoring sheet (high score suggests need to see a vascular anomaly specialist, ideally within 4-6 weeks of life)
  • Management may be watchful waiting, topical timolol (low risk = local therapy), or PO propranolol (high risk = systemic therapy)
  • Examples:

Nevus Flammeus

Nevus Simplex

  • Commonly confused with nevus flammeus
  • Very common, affecting 40-60% of newborns
  • Present at birth, most commonly at the forehead, glabella, upper eyelids, and nape
    • Less common sites: back, nose, upper/lower lip, and occipital/parietal scalp
  • Appearance: lesions vary in color from pink to red, often with indistinct borders
    • Partially/completely blanchable
    • More prominent with crying, vigorous activity, or changes in ambient temp
  • Most lesions fade spontaneously with 1-2 years
  • Examples:

Blog post based on Med-Peds Forum talk by Becca Raymond-Kolker, PGY2, and Maya Tsao-Wu, PGY1

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