Board Review Questions of the Week – Skin Disorders in Newborn Infants

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This week’s case-based question:


A 1-day-old female neonate is found to have a rash above her left eye on examination. She was born at 40 weeks via spontaneous vaginal delivery requiring vacuum assistance. The neonate required blow-by oxygen upon delivery and had a delayed bath.

The neonate has been bottle-feeding well and has had 2 wet diapers and 1 meconium stool. Her vital signs have been normal since the delivery.

On examination, she is sleeping comfortably. She has dull pink macules 0.5 cm in size on her glabella, eyelids, and upper lip. She also has a left-sided cephalohematoma. There is no conjunctivitis or eyelid edema, and her extraocular movements are intact. She has no jaundice. Her lungs are clear; she has no murmur and no organomegaly. The rest of the examination is normal.

The Figure demonstrates the appearance of the dermatologic lesions.

Figure 1

What is the probable course of the facial lesions?

Answer Options

fading almost completely within 3 weeks
fading almost completely within 3 years
enlarging rapidly during the first year, then spontaneously involuting within 3 years
deepening and enlarging within 3 years, requiring laser therapy for complete resolution
no change in size or color over time

And the answer is …


Correct Answer:

fading almost completely within 3 years

Educational Objective:

Recognize the course of action of nevus simplex (salmon patch).

Key Point:

Nevus simplex or salmon patch occur commonly over the face and self-resolve by 3 years.

Explanation:

Due to the size and location of this vascular lesion, it appears to be a salmon patch, which is thought to be due to a persistence of fetal circulation. These lesions are asymptomatic and benign, and tend to fade within a few years. Other common locations are the nape of the neck and the forehead.

Hemangioma is a benign vascular proliferation that rapidly enlarges during the first year and spontaneously involutes by 2 or 3 years of age. Superficial hemangiomas are bright red with a nodular consistency and are called strawberry hemangiomas. Deeper ones are purple and called cavernous hemangiomas.

A port wine stain is a macular vascular patch made of dilated blood vessels. It is typically benign but can be associated with other abnormalities and syndromes.

All newborns with rashes should be closely examined to rule out serious disease. The vacuum extraction yields the possibility of local bruising and damage to the head and face. Further workup of the neonate would be required if she showed signs of eye injury.

References:

Cohen BA, Davis HW, Gehris RP. Dermatology. In: Zitelli BJ, et al. Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis. 6th ed., 2012:299-368.

Haveri FT, Inamadar AC. A cross-sectional prospective study of cutaneous lesions in newborn. ISRN Dermatol. 2014;2014:360590.

Martin KL. Diseases of the neonate. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed., 2015:3116-3118.

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