Children’s Skin and Hair Disorders

NEONATAL PERIOD AND EARLY INFANCY

Toxic erythema of newborn

This is a self-limiting benign condition with onset usually 24–48 hrs after birth (up to 14 days). Erythematous macules mainly on face and trunk. Flea-bitten appearance. Resolves spont. in a few days. No treatment required.

Transient neonatal pustular dermatosis

This is a blistering eruption with pustules presenting at birth or in the first few hours of life. Occurs mainly on the trunk and buttocks. No treatment required.

Naevus flammeus (salmon patch)

Dilated capillaries form on face and eyelids (~50% of babies) and nape of neck or between eyelids (‘angel’s kiss’). Fades over 6–12 mths but neck patches may persist into adult life. No treatment required.

Capillary malformation (port wine stain)

Present from birth—surgery inadvisable. Assessment for underlying vascular abnormalities advised if the lesion is in the area supplied by the ophthalmic or maxillary divisions of the trigeminal nerve. Consider the Sturge–Weber syndrome—associated intellectual disability and epilepsy.

The stains can be considered for pulsed dye laser therapy—probably best in first 2 yrs or when the colour changes to bluish-red, usually in early adulthood. Cosmetic camouflage useful.

Infantile haemangioma (strawberry naevus)

Usually on head and neck. Starts as a pinpoint red lesion at birth and grows up to the age of 6–12 mths, then slow involution up to 5–10 yrs. Reassure parents and show how to stop any bleeding. Worst complication is ulceration (use dressings with DuoDERM or IntraSite gel). Active non-treatment is the rule but beta blockers have proven effectiveness, e.g. oral propranolol (with caution) and topical timolol drops or gel. Lasers can promote healing but treatment usually unnecessary. Refer lesions on eyelids and multiple lesions.

Sebaceous hyperplasia

Hyperplastic sebaceous glands appear as tiny yellow-white papules on the nose at birth, esp. at the tip. Disappear in several wks.

Naevus sebaceous

This is a variation of sebaceous hyperplasia usually found on the head or neck as a yellow-orange coloured circumscribed or linear lesion. Leave it to resolve.

Congenital naevi

These have to be treated on an individual basis. If giant naevi, they can be dermabraded at ideally <6 wks.

Benign juvenile melanoma

Brown pigmented lesions on face are usually surgically excised because of rapid growth and family concerns.

Milia

Blocked sebaceous glands, esp. on the face, are present in 50% of neonates. The firm white papules are ~1–2 mm in diameter and differ from the yellowish papules of sebaceous hyperplasia. Also disappear after several weeks.

Miliaria (‘sweat rash’)