Photo Quiz

Erythematous Lesion on a Newborn's Scalp

 

Am Fam Physician. 2017 Nov 15;96(10):673-674.

A 24-year-old woman (gravida 1 para 1) gave birth via spontaneous vaginal delivery. At birth, the newborn had a red lesion on the crown of her head. There was no family history of congenital skin abnormalities. Prenatal laboratory test results were normal.

The newborn examination revealed a 3.5- × 2-cm erythematous lesion on the scalp (Figures 1 and 2). The lesion was well-circumscribed and surrounded by a collar of hair. Ultrasonography revealed an anechoic subcutaneous mass that was 14 × 18 × 6 mm in size. The lesion was not connected to the brain.

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Figure 1.


Figure 1.

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Figure 2.


Figure 2.

Question

Based on the patient's history, physical examination, and ultrasound findings, which one of the following is the most likely diagnosis?

A. Aplasia cutis congenita.

B. Epidermolysis bullosa.

C. Erosion from herpes simplex virus.

D. Nevus sebaceus.

Discussion

The answer is A: aplasia cutis congenita. Aplasia cutis congenita is the absence of skin in a localized area of the scalp or trunk. It may be associated with other rare congenital syndromes such as epidermolysis bullosa, trisomy 13 syndrome, and limb defects.1,2 The condition is underreported, and some estimate that it occurs in one out of 3,000 births.3 It may be inherited in an autosomal dominant or recessive pattern.3 There are several types of aplasia cutis congenita. This newborn had the membranous form, which is most common.

Membranous aplasia cutis congenita is characterized by oval or round, well-circumscribed lesions with a punched-out appearance. They are usually less than 1 cm in size.1 The surface is atrophic, thin, glistening, and membrane-like.1 Bullous lesions that are drained may reform to the more typical flat appearance. The most common location

Address correspondence to Ahmed Abusamra, MD, at aabusamra82gmail.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Frieden IJ, Eichenfield LF, Mathes EF, Zaenglein AL, eds. Neonatal and Infant Dermatology. 3rd ed. London, England: Elsevier; 2015....

2. Kliegman RM, Nelson WE, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016.

3. Marneros AG. Genetics of aplasia cutis reveal novel regulators of skin morphogenesis. J Invest Dermatol. 2015;135(3):666–672.

4. Habif TP, ed. Clinical Dermatology: a Color Guide to Diagnosis and Therapy. 6th ed. St. Louis, Mo.: Elsevier; 2016.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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