Neonatal skin disorders and birthmarks

Overview & Definition

A newborn's skin is doing two jobs at once: adapting to dry air after months in amniotic fluid, and carrying the marks of how it formed. Both jobs produce lesions. Most are harmless and fleeting; a small number mark a disorder that will shape the child's whole childhood. The clinician's task at the cot side is to tell those two groups apart without sending every worried parent to a specialist. [11]

Neonatal skin disorders and birthmarks span three practical groups. Benign and transient lesions — erythema toxicum neonatorum, transient neonatal pustular melanosis, milia, sebaceous hyperplasia, miliaria, dermal melanocytosis (the Mongolian spot) and harlequin colour change — are common, self-limiting, and need only explanation and reassurance. [11] [12] Birthmarks divide into vascular and pigmented. Vascular birthmarks use the biological classification of Mulliken and Glowacki, which separates proliferating vascular tumours (chiefly infantile haemangioma) from vascular malformations present at birth (port-wine stain, venous, lymphatic and arteriovenous malformations). [1] Pigmented birthmarks include the congenital melanocytic naevus and dermal melanocytosis. [13]

The single idea that organises everything is this: a lesion's distribution and natural history are more informative than its colour. A red stain on a forearm is usually nothing; the same red stain on the forehead, or a rapidly growing red plaque beside an eye, demands a work-up. A blue patch over the sacrum fades and is forgotten; a brown patch over the lower spine may tether the cord. Keep that lens and the rest follows. [4]

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1. [1]Mulliken JB, Glowacki J Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plastic and Reconstructive Surgery, 1982.PMID 7063565
2. [2]Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A Propranolol for severe hemangiomas of infancy. New England Journal of Medicine, 2008.PMID 18550886
3. [3]Haggstrom AN, Drolet BA, Baselga E, et al. Prospective study of infantile haemangiomas: demographic, prenatal, and perinatal characteristics. Journal of Pediatrics, 2007.PMID 17307549
4. [4]Darrow DH, Greene AK, Mancini AJ, Nopper AJ (American Academy of Pediatrics) Diagnosis and management of infantile hemangioma. Pediatrics, 2015.PMID 26416931
5. [5]Drolet BA, Frommelt PC, Chamlin SL, et al Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics, 2013.PMID 23266923
6. [6]Pope E, Lara-Corrales I, Sibbald C, et al. Noninferiority and safety of nadolol vs propranolol in infants with infantile hemangioma: a randomized controlled trial. JAMA Pediatrics, 2022.PMID 34747977
7. [7]Baselga E, Dembowska-Baginska B, Przewratil P, et al. Efficacy of propranolol between 6 and 12 months of age in high-risk infantile hemangioma. Pediatrics, 2018.PMID 30082451
8. [8]Metry DW, Haggstrom AN, Drolet BA, et al Consensus statement on diagnostic criteria for PHACE syndrome. Pediatrics, 2009.PMID 19858157
9. [9]Shirley MD, Tang H, Gallione CJ, et al Sturge-Weber syndrome and port-wine stains caused by somatic mutation in GNAQ. New England Journal of Medicine, 2013.PMID 23656586
10. [10]Leung AK, Kao CP, Leung AA Persistent Mongolian spots in Chinese adults. International Journal of Dermatology, 2005.PMID 15663659
11. [11]Patrizi A, Neri I, Ricci G, et al. Advances in pharmacotherapeutic management of common skin diseases in neonates and infants. Expert Opinion on Pharmacotherapy, 2017.PMID 28429969
12. [12]Chadha A, Jahnke M Common neonatal rashes. Pediatric Annals, 2019.PMID 30653638
13. [13]Krengel S, Scope A, Dusza SW, Vonthein R, Marghoob AA New recommendations for the categorization of cutaneous features of congenital melanocytic nevi. Journal of the American Academy of Dermatology, 2013.PMID 22982004