A 3-week-old full-term boy is brought to the pediatric outpatient clinic by his parents due to a new facial rash. The parents first noticed the lesions 4 days ago, and they have gradually increased in number. The infant is exclusively breastfed, feeds vigorously, and has appropriate wet and dirty diapers. Vital signs are within normal limits. Physical examination reveals multiple scattered inflammatory papules and pustules located on the cheeks, chin, and forehead. There are no open or closed comedones. The remainder of the skin examination is unremarkable. Which of the following is the most appropriate next step in management?
- AObtaining a swab of the pustules for bacterial culture
- BApplication of topical clotrimazole cream
- Parental education and daily washing with mild soapAnswer
- DInitiation of oral cephalexin therapy
- EPrescription of topical hydrocortisone therapy
Answer
Parental education and daily washing with mild soap
The patient's presentation of inflammatory papules and pustules on the face at approximately 3 weeks of age, in the absence of comedones, is the classic description of neonatal cephalic pustulosis. Unlike infantile acne, which occurs later (usually 3-4 months) and features comedones, neonatal cephalic pustulosis is a common, benign, and transient condition. The pathophysiology is thought to involve an inflammatory reaction to Malassezia colonization. Because the condition is self-limited and the infant is otherwise well-appearing and feeding normally, the most appropriate management is reassurance, parental education, and routine gentle cleansing with water or mild soap.
Step-by-Step Solution
Key Concept
Neonatal cephalic pustulosis is a benign, self-limiting condition presenting around 3 weeks of age with facial pustules lacking comedones, managed purely with supportive care and gentle cleansing.