Match each clinical presentation of a neonatal skin finding to the most likely diagnosis.
- A 2-day-old full-term infant develops a generalized eruption of 1 to 3-mm yellowish pustules on a broad erythematous base, sparing the palms and soles. A smear of the pustule contents reveals numerous eosinophils.Erythema toxicum neonatorum
- A newborn infant is noted immediately after delivery to have scattered superficial vesicles and pustules that rupture easily, leaving behind a collarette of scale and hyperpigmented macules. A smear of a pustule reveals neutrophils.Transient neonatal pustular melanosis
- A 3-week-old infant is brought to the clinic for an eruption of inflammatory erythematous papules and pustules localized exclusively to the face and scalp. No comedones are present.Neonatal cephalic pustulosis
- A healthy 1-day-old infant is noted to have multiple 1 to 2-mm firm, pearly-white papules scattered across the nose, cheeks, and chin. The lesions do not have an erythematous base.Milia
Answer
The correct matches correctly identify benign neonatal skin conditions by their distinct timing, morphology, and cellular content (Erythema toxicum neonatorum with eosinophils at 24-72 hours, Transient neonatal pustular melanosis with neutrophils at birth, Neonatal cephalic pustulosis at 3 weeks, and Milia as pearly keratin cysts).
Each clinical vignette provides pathognomonic features for common benign neonatal dermatoses. Erythema toxicum neonatorum typically appears at 24-72 hours of life with a 'flea-bitten' rash packed with eosinophils. Transient neonatal pustular melanosis is present at birth, yields neutrophils, and leaves hyperpigmented macules with a collarette of scale. Neonatal cephalic pustulosis appears at 2-3 weeks of life on the head and neck without comedones, distinguishing it from infantile acne. Milia are small keratin-filled cysts presenting as non-inflammatory pearly-white papules on the face.
Step-by-Step Solution
Key Concept
Differentiating benign neonatal skin eruptions based on onset time, lesion morphology, and microscopic cellular findings.