Thread by @ClementLeeMD

I just finished another week rounding in the nursery and had a great time. I love my job! 👶🏼👩🏾‍🍼

Here are 7 common baby rashes that we didn’t cover last time.

#PedsTwitter #MedTwitter

1. Pink patches on the face

This is a nevus simplex (aka salmon patch/stork bite/angel kiss). 👼🏻💋

They can worsen with crying and go away with time. They're usually on the forehead/eyelids and have feathery borders (vs. a port-wine stain). They're actually not nevi (moles) but capillary dilations.

2. Dark patch on the buttock

This is congenital dermal melanocytosis (CDM).

More common in dark-skin and Asian babies and was once aka “Mongolian spots” (derogatory). They're usually on the buttocks/back and disappear w/ time. Have your doctor document these bc they can be mistaken for child abuse. 🩻

3. Small pimples w redness all over the body

This is erythema toxicum. I hate the name because they're NOT toxic.

Look for pustules on a red base all over the body except palms & soles. ✋🏽🦶🏽 We don’t really know what causes them but they are more common in lighter skin types and the lesions contain eosinophils.

4. Small pimples all over the body, with other findings

This is TNPM (transient neonatal pustular melanosis).

More common in dark babies, these can be on palms/soles and are fragile. They pop, peel & leave darker skin (hyperpigmentation); it’s rare to see only pustules. We also don’t know the cause but it involves neutrophils. 👶🏿

5. Pimples on the face

This is neonatal acne, which is rare.

These will NOT be present at birth because it takes time for baby’s skin to react (we think it has to do with mom’s hormones + reaction to environment/fungi). Unlike real acne, there are NO comedones (whiteheads or blackheads). 🍄

6. Flakes in the hair or on the face (can also be in the groin)

This is seborrheic dermatitis (cradle cap).

It’s similar to dandruff in adults. I recommend gentle baby shampoo or ointments (e.g. Vaseline) to loosen the scales, then brushing them off with a toothbrush. 🪥 Sometimes antifungal shampoo or steroids can be used.

7. See-through rash, maybe with some blood vessels

This is an early infantile hemangioma.

When these mature, they can get beefy red ("strawberry"). Have your doctor monitor these, esp. if disfiguring, large, on the chin, or there are many of them. Complications include breathing problems, vision loss, and low thyroid levels. 🍓

That's all for now! For those who haven’t seen the previous thread about other common neonatal issues, please refer to this tweet:

https://twitter.com/ClementLeeMD/status/1618416211590778881?s=20&t=cpeSwEkf1e1IW4rPda6JeQ

Thanks for reading! Hope you learned something.

PC: @VisualDX (esp. of dark-skinned babies!)

#PedsTwitter, #DermTwitter, any others?

@drkatielockwood @MichaelCosimini @DrStevenTChen @Kidsdoc1Rick @DrJaimeFriedman @JohnDanielMD @DrSelvarajah @Dr_ScottK @DoctorVig @SamirShahMD