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Question

Difficulty: EasyNeonatal Disorders

Review the following physical examination findings of skin lesions in newborn infants. Associate each dermatologic presentation with its corresponding diagnosis.

  • A 48-hour-old infant develops multiple erythematous macules on the trunk and extremities, some containing central yellow pustules; a smear of the pustules reveals numerous eosinophils.Erythema toxicum neonatorum
  • A neonate is noted at birth to have scattered superficial pustules that easily rupture, leaving behind hyperpigmented macules with a collarette of scale; a smear reveals neutrophils.Transient neonatal pustular melanosis
  • A 24-hour-old infant presents with numerous tiny, 1-to-2 millimeter pearly white papules clustered over the nose, cheeks, and chin without surrounding erythema.Milia
  • A 21-day-old infant develops inflammatory papules and pustules confined to the face and scalp, notably lacking comedones.Neonatal cephalic pustulosis

Answer

The presentations match as follows: The infant with eosinophil-filled pustules has Erythema toxicum neonatorum. The newborn with neutrophil-filled pustules and hyperpigmented macules has Transient neonatal pustular melanosis. The infant with pearly white facial papules has Milia. The 21-day-old with facial papules lacking comedones has Neonatal cephalic pustulosis.
The correct pairings rely on identifying the classic distinguishing features of benign neonatal rashes. Erythema toxicum neonatorum typically appears a few days after birth and features eosinophil-filled pustules on an erythematous base. In contrast, Transient neonatal pustular melanosis is present at birth, lacks an erythematous base, contains neutrophils, and leaves hyperpigmented macules. Milia are simple keratin-filled cysts appearing as pearly white papules. Neonatal cephalic pustulosis presents later (around 3 weeks) with facial papules that specifically lack the comedones seen in true acne.

Step-by-Step Solution

1
Analyze the first presentation involving an erythematous rash with eosinophil-filled pustules appearing at 48 hours of life.
This pattern points to a common, benign newborn rash.
The presence of eosinophils and an erythematous base are the classic hallmarks of Erythema toxicum neonatorum.
2
Evaluate the second presentation involving neutrophil-filled pustules present at birth that leave hyperpigmented macules.
This indicates a specific transient eruption seen in neonates.
The lack of surrounding erythema, presence at birth, and neutrophil content define Transient neonatal pustular melanosis.
3
Assess the third presentation involving 1-to-2 millimeter pearly white papules on the face.
This indicates retention of keratin and sebaceous material.
These pinpoint white papules are characteristic of Milia.
4
Review the fourth presentation involving inflammatory facial papules at 3 weeks of age without comedones.
This indicates a condition similar to acne but lacking true comedones.
The timing and absence of comedones are the key distinguishing features of Neonatal cephalic pustulosis.

Key Concept

Differentiating benign neonatal skin eruptions based on timing of onset, physical appearance, and cellular contents of pustules.
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Topics

Neonatal Disorders

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