Pediatric emergency medicine trisk 2476 2476
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Benign Rashes
Various papular rashes may be observed in the healthy newborn. Characteristic
body distribution patterns and age at appearance help differentiate these rashes
from more worrisome conditions. Diagnosis can be made by physical
examination alone and do not require further evaluation or specific treatment.
Parents should be reassured these are not worrisome conditions.
Milia are small 1- to 2-mm ivory or yellow papules located primarily on the
forehead, nose, and cheeks of newborns. Milia are keratin retention cysts. They
will spontaneously rupture and disappear during the first 3 to 4 weeks of life (
Fig. 96.4 ). Miliaria, or neonatal prickly heat, is caused by sweat retention and is
characterized by easily ruptured, 1- to 2-mm vesicles located primarily on the
face chest and back. Erythema toxicum is a more generalized eruption of small
papules or pustules on an erythematous base that may occur anywhere on the
body. Usually presenting during the first 3 to 4 days of life, these lesions may be
noted as late as 2 weeks of age. If the diagnosis is in question, a smear of the
papular contents will show a predominance of eosinophils with no organisms and
relative absence of neutrophils ( Fig. 96.5 ). Neonatal acne is characterized by
erythematous papules or pustules confined primarily to cheeks, chin, and
forehead. Lesions are caused by circulating maternal hormones, usually appear at
3 to 4 weeks of age and disappear within a few weeks ( Fig. 96.6 ). Diaper rash is
located on the skin covered by the diaper. Irritants and contact dermatitis are often
the initial precursor to the rash. Candida infections are common and diagnosed if
the rash is present in the intertriginous folds. Candida infections are beefy red
with well-demarcated borders and satellite papules and pustules. Mostly a clinical
diagnosis, candida can be confirmed if necessary by microscopic examination
looking for budding yeasts and pseudohyphae.
