Neonatal Period

Neonatal period is defined as the first 28 days after birth. During this critical period of time, several dermatological problems associated with neonates can arise, which can range in severity from benign to life-threatening. Common issues that can be encountered during the neonatal period include transient erythema toxicum, milia, nasal asymmetry, mongolian spots, dermal nevi, skin tags, mucous cysts, and harlequin color change. Transient erythema toxicum is a benign, self-limiting rash that appears within the neonatal period on approximately 60-70% of healthy newborns. The rash appears as small, red or white-topped papules, and can be seen on the face, trunk and extremities. Treatment is generally not necessary, as the rash typically resolves without intervention. Milia are small cysts filled with keratinocytes, and typically affect newborns during the first week of life, particularly around the nose, forehead and cheeks. Another common skin lesion in the neonatal period is the mongolian spot. These are flat, blue-gray macules usually present along the lumbosacral area and can be seen in newborns of various races and skin colors. They typically resolve without intervention by the time the baby is five to six years of age. Dermal nevi are relatively common during the neonatal period, with most cases being of the common, acquired variety. These lesions are usually asymptomatic and benign, though approximately 1% of dermal nevi can present with malignant transformation. Therefore, dermal nevi should be monitored and any lesions that become symptomatic should be referred to a dermatologist for further investigation. Skin tags, mucous cysts, and harlequin color change can also arise during the neonatal period. Skin tags are typically fleshy projections extending from the skin, and often occur in the neck and groin area. Mucous cysts are usually present on the lips, and are filled with a thick, light-yellow mucous material. Lastly, harlequin color change is a rare condition characterized by unilateral evanescent erythema leading to a "harlequin" pattern, and is usually self-resolving.