The skin of newborn infants may be covered by vernix caseosa, a white lipid-containing material. The skin barrier function is normal at full-term birth, but impaired if premature. Table 26.1 lists skin conditions seen in newborn infants.

Warning

Skin barrier function is impaired in premature neonates, so increased risk systemic absorption of topical steroids.

Benign Physiological Phenomenon

Cutis marmorata is a transient, net-like mottled violaceous discoloration caused by a normal physiological response to a cool environment (Figure 26.1). Persistent cutis marmorata may be associated with limb hypertrophy and macrocephaly.

Benign Skin Pigmentation

Mongolian blue spots are slate-grey to blue flat patches on the lower back or buttocks in neonates of Asian, Oriental or Afro-Caribbean origin (Figure 26.2). They are benign and disappear with time.

Transient Rashes

Neonatal Acne

Infants present with papules and pustules on the cheeks which resolve after a few months. The condition results from stimulation of neonatal sebaceous glands by trans-placental transfer of maternal adrenal androgens. Acne cysts may develop, requiring systemic antibiotics such as erythromycin to prevent scarring.

Miliaria

Miliaria are multiple clear to yellowish vesicles seen on the face of neonates, especially in warm and humid environments, caused by blocked and/or immature sweat ducts. They resolve spontaneously.

Toxic Erythema of the Newborn

This is an erythematous macular rash with yellow papules containing eosinophils. It occurs on the face, trunk and limbs in the first few days of life and resolves spontaneously over a few days.

Transient Neonatal Pustular Melanosis

This is an asymptomatic rash of unknown aetiology which appears on the first day of life. It consists of vesicles and pustules on the trunk, palms and soles which then rupture to form pigmented macules. It resolves spontaneously over a few months.

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