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Pediatr Ann 2019 Jan;48(1):e16-e22

Skin eruptions are commonly encountered in the neonatal and infant period and can be a source of concern for providers and parents alike. We present a brief, clinically focused discussion on topics commonly encountered by the pediatrician with a focus on pearls of knowledge to help distinguish diseases from one another and from more serious conditions. We review miliaria, transient neonatal pustular melanosis, neonatal cephalic pustulosis, erythema toxicum neonatorum, diaper dermatitis, seborrheic dermatitis, and atopic dermatitis. Read More

J Pediatr Gastroenterol Nutr 2018 Nov;67(5):610-615

Department of Pediatrics, Walter Reed National Military Medical Center.

Objectives: Eosinophilic esophagitis (EoE) is an inflammatory, atopic disease of the esophagus without a clear etiology. Our objective was to identify exposures and conditions in early infancy associated with the development of EoE.

Methods: A case-control study was performed using the Military Health System Database. Read More

Pediatr Dermatol 2017 Jul 25;34(4):422-426. Epub 2017 May 25.

Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.

Background/objectives: Erythema toxicum neonatorum (ETN) and transient neonatal pustular melanosis (TNPM) are benign pustular skin conditions that are relatively common in newborns, but the predisposing factors for these conditions are unknown. Our goal was to verify the prevalence of ETN and TNPM and their predisposing factors in a large sample of neonates.

Methods: In this prospective 1-year multicenter study, 2,831 neonates (age ≤72 hours) born in southern Brazil were randomized to undergo skin examination by a dermatologist. Read More

Expert Opin Pharmacother 2017 May 21;18(7):717-725. Epub 2017 Apr 21.

a Dermatology, Department of Experimental, Diagnostic and Specialty Medicine , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy.

Introduction: neonatal and infantile skin diseases are frequently encountered in the clinical practice and represent worldwide a socioeconomic issue. They encompass a wide range of acquired or congenital conditions, including infections, vascular lesions and inflammatory diseases and can present with different degrees of severity, leading in some cases to dramatic complications. Areas covered: In this paper we report the most recent evidences on the management of some common skin diseases in neonates and infants. Read More

Curr Pediatr Rev 2017 ;13(2):136-143

Department of Dermatology, Apollo Institute of Medical Sciences and Research, Hyderabad, 500 033. India.

Background: Variation in neonatal skin changes and clinical presentation is a frequent occurrence. We studied the pattern of cutaneous manifestations in new-borns <72 hours of birth.

Method: We included all live babies delivered in our hospital; Babies were categorised according to age, birth weight and gestational age. Read More

FP Essent 2017 Feb;453:11-17

University of North Carolina Chapel Hill School of Medicine Dermatology Residency Program, 410 Market St. Suite 400 CB#7715, Chapel Hill, NC 27516.

Skin findings during the initial month of life are ubiquitous. One study estimated that more than 95% of newborns have cutaneous findings, which often are distressing to parents but frequently are benign and self-limited. Among them are milia, cutis marmorata, congenital dermal melanocytosis, and the benign neonatal pustular eruptions (eg, benign cephalic pustulosis, erythema toxicum neonatorum, transient neonatal pustular melanosis). Read More

J Pediatr (Rio J) 2017 May - Jun;93(3):238-245. Epub 2016 Nov 19.

Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Saúde da Criança e Adolescente, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Departamento de Dermatologia, Porto Alegre, RS, Brazil.

Objective: To determine the prevalence of neonatal dermatological findings and analyze whether there is an association between these findings and neonatal and pregnancy characteristics and seasonality.

Methods: Newborns from three maternity hospitals in a Brazilian capital city were randomly selected to undergo dermatological assessment by dermatologists.

Results: 2938 neonates aged up to three days of life were randomly selected, of whom 309 were excluded due to Intensive Care Unit admission. Read More

An Bras Dermatol 2016 Apr;91(2):124-34

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

The neonatal period comprises the first four weeks of life. It is a period of adaptation where the skin often presents several changes: transient lesions, resulting from a physiological response, others as a consequence of transient diseases and some as markers of severe disorders. The presence of pustules in the skin of the newborn is always a reason for the family and for the assisting doctor to be worried, since the newborn is especially vulnerable to bacterial, viral or fungal infection. Read More

Indian J Dermatol 2015 Nov-Dec;60(6):635

Department of Dermatology, Venereology and Leprosy, Government Medical College, Surat, Gujarat, India.

Background: Dermatologic conditions have different presentation and management in pediatric age group from that in adult; this to be studied separately for statistical and population based analysis.

Objective: To study the pattern of various dermatoses in infants and children in tertiary health care center in South Gujarat region.

Materials And Methods: This is a prospective study; various dermatoses were studied in pediatric patients up to 14 years of age attending the Dermatology OPD of New Civil Hospital, Surat, Gujarat over a period of 12 months from June 2009 to June 2010. Read More

Indian J Dermatol 2015 Mar-Apr;60(2):211

Department of Skin and VD, PGIMS, Rohtak, Haryana, India.

Neonatal pustular eruption is a group of disorders characterized by various forms of pustulosis seen in first 4 weeks of life. Its presentation is often similar with some subtle differences, which can be further established by few simple laboratory aids, to arrive at a definite diagnosis. Given their ubiquitous presentation, it is sometimes difficult to differentiate among self-limiting, noninfectious, pustular dermatosis such as erythema toxicum neonatorum, transient neonatal pustular melanosis, miliaria pustulosa, etc. Read More

Indian J Dermatol 2014 Nov;59(6):552-7

Department of Community Medicine, Dr. D.Y. Patil Medical College, Pimpri, Pune, Maharashtra, India.

Background: The spectrum of dermatological manifestations during neonatal period varies from transient self-limiting conditions to serious dermatoses; the latter, fortunately few, are disproportionately stressful to the parents, who due to lack of specialized pediatric dermatology clinics frequently get tossed between a dermatologist and a pediatrician.

Objectives: This study was formulated to record cutaneous changes over the first five postnatal days of life and to statistically correlate those changes occurring in ≥ 11 neonates with three (parity, associated illnesses, and mode of delivery) maternal and three (sex, birth weight, and gestational age) neonatal factors.

Methods: This descriptive, cross-sectional study at a tertiary care hospital entailed recording detailed dermatological examination of 300 neonates having some (physiological and/or pathological) cutaneous changes and their statistical evaluation using the Chi-square test and significance (P < 0. Read More

Orv Hetil 2014 Mar;155(13):500-8

Szegedi Tudományegyetem, Általános Orvostudományi Kar Szülészeti és Nőgyógyászati Klinika Szeged.

Introduction: At present there are no exact epidemiologic data on the prevalence of neonatal skin disorders and birth marks in Hungary.

Aim: The aim of the authors was to investigate the prevalence of skin disorders in mature healthy neonates after birth.

Method: The survey was carried out in the Neonatal Care Unit at the Department of Obstetrics and Gynaecology at the University of Szeged between April, 2012 and May, 2013. Read More

ISRN Dermatol 2014 20;2014:360590. Epub 2014 Jan 20.

Department of Dermatology, Shri B. M. Patil Medical College, BLDE University, Bijapur, Karnataka 586103, India.

Background. Cutaneous alterations are common in neonates. The majority of lesions are physiological, transient, or self-limited and require no therapy. Read More

J Med Assoc Thai 2013 Jan;96 Suppl 1:S49-53

Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.

Background: The prevalence of birthmarks and cutaneous skin lesions in newborns vary among sex and race. There are limited reports of birthmarks and cutaneous lesions among Thai neonates.

Objective: To determine the prevalence of birthmarks and cutaneous lesions in Thai newborns and evaluate the association between age, gender maturity, route of delivery, birth weight and skin lesions. Read More

FP Essent 2013 Apr;407:31-41

San Joaquin General Hospital, French Camp, CA 95231, USA.

Infants exhibit many skin rashes. Erythema toxicum neonatorum presents as erythematous macules, papules, and pustules on the face, trunk, and extremities; it typically resolves spontaneously within 1 week. Neonatal acne presents as comedones or erythematous papules on the face, scalp, chest, and back. Read More

Ann Dermatol 2013 Feb 14;25(1):1-4. Epub 2013 Feb 14.

Department of Dermatology, Ankara Etlik Ihtisas Education and Research Hospital, Ankara, Turkey.

Background: Cutaneous lesions are commonly seen in the newborn period and exhibit inconsistency from the skin lesions of an adult.

Objective: The present study was carried out with an aim to determine the frequency of physiologic and pathologic cutaneous findings in newborns.

Methods: Typically, 1234 newborns were included in this study. Read More

J Pediatr 2012 Aug 11;161(2):240-5. Epub 2012 Apr 11.

Division of Pediatrics and Dermatology, University of California San Diego School of Medicine, San Diego, CA 92123, USA.

Objective: To provide incidence data based on ethnicity, prematurity, and body site for vascular, pigmented, and other common congenital cutaneous findings; to compare these results with previously published prospective studies; and to define updated nomenclature, classification, clinical course, and prognostic factors for the pediatric practitioner to promote a better understanding of benign versus more worrisome birthmarks.

Study Design: This prospective study enrolled 594 infants in San Diego, California. Cutaneous examination was performed by pediatric dermatologists in the first 48 hours of life, with subsequent longitudinal contact via telephone, and repeat evaluations if any new lesions were reported by parents. Read More

J Dermatol Case Rep 2011 Dec;5(4):58-63

Department of Dermatology Venereology and Leprology, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh, India.

Background: The entity vesicobullous disorders in neonates encompasses a varied spectrum of disorders varying from self limiting to potentially life threatening infectious diseases.

Objective: To analyse the incidence of dermatoses in neonates, stress the importance of simple noninvasive diagnostic procedures with perspective to actual need of active intervention.

Patients And Methods: Forty four neonates with vesicobullous lesions in departments of dermatology and pediatrics were evaluated with respect to diagnosis, required treatments and follow ups. Read More

Pediatr Dermatol 2012 Mar-Apr;29(2):166-8. Epub 2011 Nov 8.

Department of Dermatology, Hospital Arquitecto Marcide, Área Sanitaria de Ferrol, Consellería de Sanidade e Servicio Galego de Saúde, Ferrol, Spain.

We performed a prospective study of 1,000 neonates investigated in the first 72 hours of life in the health area of Ferrol (northwest of Spain) to assess the prevalence of erythema toxicum neonatorum, the anatomical sites most frequently involved, the influence of different maternal and neonatal parameters, day of life of medical examination, and type of delivery (vaginal or Cesarean). Overall prevalence of erythema toxicum neonatorum was 16.7%. Read More

Indian J Pediatr 2011 Oct 25. Epub 2011 Oct 25.

Department of Dermatology, Venereology and Leprology, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh, India.

Objective: To analyse the incidence of dermatoses in neonates, stress the importance of simple noninvasive diagnostic procedures with perspective to actual need of active intervention.

Methods: Forty four neonates with vesicobullous lesions in Departments of Dermatology and Pediatrics were evaluated with respect to diagnosis, required treatments and follow ups.

Results: Of the total 44 neonates, 29 were boys and 15 girls. Read More

Pediatr Dermatol 2012 Mar-Apr;29(2):232-3. Epub 2011 Oct 13.

Department of Dermatology, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.

Two hundred forty-seven healthy newborns were investigated in a prospective cohort descriptive study. Information on phenotype and obstetric and parental history was collected. A positive association was found between erythema toxicum neonatorum and season of birth (spring and summer), whereas parental history of any skin disease was related to a lower frequency of this eruption. Read More

Pediatr Dermatol 2011 Jul-Aug;28(4):387-92

Division of Neonatology, Department of Pediatrics, University College of Medical Sciences, Delhi, India.

There is paucity of literature on the incidence and clinical associations of transient benign dermatological conditions in twin neonates. This prospective study evaluated 253 live-born twin babies (≥23 wks) at a tertiary care hospital in Delhi, India. All study subjects were observed for the first 7 days of life, and regular dermatological examination was performed. Read More

Actas Dermosifiliogr 2011 Nov 8;102(9):726-9. Epub 2011 Apr 8.

Servicio de Dermatología, Hospital Arquitecto Marcide, Área Sanitaria de Ferrol, SERGAS, Ferrol, La Coruña, Spain.

At birth, vernix caseosa can cover the whole body surface or accumulate only on the back and in the skin folds. Interest in its composition and function and its possible applications in adults has increased in recent years. The objective of this study was to determine the prevalence of vernix caseosa in newborn infants in the health care area of Ferrol, Spain, and to assess its relationship with neonatal and maternal factors. Read More

Eur J Dermatol 2011 Mar-Apr;21(2):271-2

Indian Pediatr 2010 Sep;47(9):793

Department of Dermatology, Venereology and Leprosy, Dr RP Government Medical College Kangra (Tanda) 176 001. HP, India.

Einstein (Sao Paulo) 2010 Jun;8(2):143-8

Universidade Católica de Santos - UNISANTOS, Santos, SP, BR.

Objectives: To verify the incidence of skin diseases in newborns of pregnant women at risk of a public hospital in the city of Santos, Brazil (Hospital Guilherme Alvaro), determining the potential relation between these dermatoses and diseases presented by the mothers.

Methods: A total of 1,000 neonates were examined in the first 36 hours of life. The examination was repeated daily in each child up to hospital discharge. Read More

Ann Dermatol Venereol 2010 Feb 24;137(2):150-2. Epub 2009 Jul 24.

Service de dermatologie, hôpital Laënnec, BP 1757, 29107 Quimper cedex, France.

Cutis 2009 Jan;83(1):13-6

Dermatology and Pediatrics, New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103, USA.

Erythema toxicum neonatorum (ETN) is a common neonatal dermatologic disorder that usually is evident within the first 48 hours of life. Characteristic lesions include erythema, wheals, papules, and pustules. This transient rash resolves spontaneously without sequelae over the course of a week. Read More

Przegl Lek 2009 ;66(9):535-7

Ambulatorium z Izba Chorych, 6 Wojskowy Oddział Gospodarczy w Ustce.

The skin of newborns differs from adult skin in many aspects. It is in the developing age which makes it difficult to fulfill it's correct function. There are diseases which appear in the first month of the infants life and require treatment. Read More

Pediatr Dermatol 2008 May-Jun;25(3):411-3

Am Fam Physician 2008 Jan;77(1):47-52

Chestnut Hill Hospital Family Practice Residency Program, Philadelphia, Pennsylvania, USA.

Rashes are extremely common in newborns and can be a significant source of parental concern. Although most rashes are transient and benign, some require additional work-up. Erythema toxicum neonatorum, acne neonatorum, and transient neonatal pustular melanosis are transient vesiculopustular rashes that can be diagnosed clinically based on their distinctive appearances. Read More

Pediatr Allergy Immunol 2007 Dec;18(8):652-8

Department of Woman and Child Health, Neonatal Unit, Karolinska Institutet, Stockholm, Sweden.

Erythema Toxicum, a rash frequently present in the healthy newborn infant is an innate, immune response to the first commensal micro flora. Flushing and urtication are seen in this manifestation suggesting mast cell (MC) activation and MC derived mediator release. It has recently become evident that MCs participate in the protective, innate immune response against microbes also by secreting products toxic to pathogens such as cathelicidin peptide antibiotics. Read More

Pediatr Dermatol 2007 Sep-Oct;24(5):474-82

Division of Neonatology, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.

At birth, commensal microbes penetrate into the skin of the human newborn, eliciting an acute rash, erythema toxicumn neonatorum. Histologically, the rash is characterized by an upregulation of proinflammatory activity and a local recruitment of immunocytes, including macrophages. High mobility group box chromosomal protein 1, a nuclear and cytosolic protein, is also a pro-inflammatory cytokine released by macrophages in response to microbial stimulation. Read More

Indian J Dermatol Venereol Leprol 2002 Nov-Dec;68(6):334-7

Department of Skin and STD, Govt. Medical College/G. N. D. Hospital, Amritsar, India.

Five hundred unselected newborn babies delivered in the Department of Obstetrics and Gynaecology, Unit II of SGBT Hospital attached to Government Medical College, Amritsar during April 2000 to October 2000 were examined for cutaneous lesions daily for the first five days after birth. Different cutaneous lesions were seen in 474(94.8%) newborns. Read More

Rev Med Chir Soc Med Nat Iasi 2006 Oct-Dec;110(4):797-800

Facultatea de Medicina, Disciplina de Puericultura, Universitatea de Medicina şi Farmacie "Gr.T. Popa", Iaşi.

(ETN) is a benign, self limited, asymptomatic skin condition, that only occurs during the neonatal period. This clinical entity is caractherized by small, sterile, erythematous papules, vesicles, and occasionally pustules, appearing on the trunk, extremities, and the face. The lesions are transitory, appear after 1-2 day of life, and regres after 5-14 days. Read More

Ned Tijdschr Geneeskd 2007 Feb;151(5):277-83

Isala klinieken, Amalia Kinderafdeling, Postbus 10.400, 8000 GK Zwolle.

Four neonates with vesicopustular skin eruptions, 1 girl and 3 boys, were diagnosed with feeding blisters, bullous impetigo, erythema toxicum neonatorum and transient neonatal pustular melanosis, respectively. The neonate with bullous impetigo was treated with antibiotics; the remaining neonates were not treated. The neonate with transient neonatal pustular melanosis developed hyperpigmentation, whereas the other neonates recovered without sequelae. Read More

Ugeskr Laeger 2006 Aug;168(33):2682-3

Roskilde Amts Sygebus Roskilde, Medicinsk Afdeling, Dematologisk Ambulatorium of Patologiafdelingen.

Pediatr Dermatol 2006 May-Jun;23(3):301-2

Pediatr Res 2005 Sep;58(3):613-6

Department of Woman and Child Health, Neonatal Unit, Karolinska University Hospital in Solna, Stockholm, Sweden.

Erythema toxicum neonatorum is a common rash of unknown etiology affecting healthy newborn infants. In this study, we postulated that the rash reflects a response to microbial colonization of the skin at birth, and that the hair follicle constitutes an "easily opened door" for microbes into the skin of the newborn. We collected microbial cultures from the skin of 69 healthy, 1-d-old infants with and without erythema toxicum to identify the colonizing flora and correlate culture results with clinical findings. Read More

Dermatology 2005 ;210(4):269-72

Department of Dermatology, Second Hospital of Xi'an Jiaotong University, Xi'an, China.

Background: Erythema toxicum neonatorum (ETN) is a very common disease, but its predisposing factors are still unknown.

Objective: To determine the predisposing factors of ETN.

Methods: Seven hundred and eighty-three neonates born in the same hospital during the same period were investigated, and the factors predisposing to ETN were evaluated in a case-control study. Read More

Dermatology 2005 ;210(4):257-8

Pediatr Dermatol 2003 Sep-Oct;20(5):377-84

Department of Woman and Child Health, Astrid Lindgren Children's Hospital Karolinska Institutet, Stockholm, Sweden.

Erythema toxicum neonatorum is a common, inflammatory skin reaction in healthy newborn infants characterized by an accumulation of activated immune cells in the lesions. Its etiology and physiologic significance are still unclear. The purpose of this study was to extend the search for possible inflammatory mediators of the rash. Read More

Br J Dermatol 2002 Dec;147(6):1127-34

Department of Woman and Child Health, Astrid Lindgren Children's Hospital, Karolinska Hospital C4:U1, Karolinska Institutet, S-171 76 Stockholm, Sweden.

Background: Peptide antibiotics are part of the surface defences against microbial intruders. However, the presence and significance of these innate immune effectors in the skin barrier of the newborn infant have not yet been appreciated. Erythema toxicum neonatorum is an inflammatory skin reaction of unknown aetiology and significance, commonly present in the healthy newborn infant. Read More

Curr Mol Med 2002 Sep;2(6):525-35

Division of Rheumatology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, 19107, USA.

Microchimerism has been defined by the presence of a low number of circulating cells transferred from one individual to another. This transfer takes place naturally during pregnancy, between mother and fetus and/or between fetuses in multi-gestational pregnancies. Furthermore, the establishment of microchimerism can also occur during blood transfusion and organ transplants. Read More

Am J Clin Dermatol 2002 ;3(6):389-400

Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

The differential diagnosis for pustular skin disorders is extensive. The distribution of the lesions and the age of the patient are characteristics that may provide strong clues to the etiology of cutaneous pustular eruptions. In adults, generalized pustular dermatoses include pustular psoriasis, Reiter's disease and subcorneal pustular dermatosis. Read More

Pediatr Dermatol 2002 May-Jun;19(3):210-5

Department of Dermatology and STD, Lok Nayak Hospital, New Delhi, India.

Pustular eruptions are commonly encountered in neonatal practice. Much confusion exists among clinicians because of the similarity in clinical lesions, paucity of relevant literature, and varied nomenclature used for these diseases. This often results in inappropriate diagnoses and therapies, besides subjecting the neonates to invasive and traumatic investigative procedures. Read More

Pediatr Dermatol 2001 May-Jun;18(3):177-87

Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.

Erythema toxicum neonatorum is a benign rash of unknown etiology, present to various degrees in most term newborns and characterized by an accumulation of eosinophils in dermal lesions. The recruitment of leukocytes to tissues implicates the involvement of adhesion molecules, cytokines, and chemokines. We therefore performed immunohistochemistry on punch biopsy specimens from cutaneous lesions of ten 1-day-old infants with erythema toxicum using specific monoclonal antibodies directed against a variety of adhesion molecules, cytokines, chemokines, and cell type-specific membrane markers. Read More

Clin Exp Dermatol 2001 May;26(3):251-5

Department of Dermatology, King's College Hospital, London, UK.

Eosinophilic pustular folliculitis (EPF) of infancy is a rare disorder which may begin in the neonatal period and cause considerable parental anxiety. It must be distinguished from other causes of a pustular eruption in neonates, including infection and erythema toxicum neonatorum, and rare disorders such as transient neonatal pustular melanosis, infantile acropustulosis and Langerhans' cell histiocytosis. Skin smears and occasionally skin biopsy may be necessary to reach a diagnosis. Read More

Arch Pediatr 1999 May;6(5):533-5

Service de dermatologie, Hôpital Laënnec, CHIC, Quimper, France.

Unlabelled: Diagnosis of pustular dermatosis occurring during the first days of life is based on clinical findings. Erythema toxicum neonatorum (ETN) is the more frequent benign self limiting eruption in the newborn.

Case Reports: Three cases of ETN with localized pustules to the genitals and perineal area are described. Read More