Photo Quiz

Facial Rash in a Newborn

 

Am Fam Physician. 2021 Nov ;104(5):523-524.

Following an uncomplicated pregnancy and full-term, spontaneous vaginal delivery, a yellowish linear plaque was noted on the cheek of the newborn (Figure 1). Laboratory test results were normal, and there was no family history of congenital skin conditions.

FIGURE 1


FIGURE 1

Question

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

  • A. Aplasia cutis congenita.

  • B. Comedo nevus.

  • C. Neonatal herpes simplex.

  • D. Sebaceous nevus.

  • E. Seborrheic dermatitis.

Discussion

The answer is D: sebaceous nevus. Also referred to as an organoid nevus, this congenital malformation is most commonly found on the scalp and face but may also occur on the forehead and neck. It typically presents as a solitary asymptomatic, yellow, well-circumscribed, smooth or plaque-like hamartoma. It is typically oval or in a linear pattern. When located on the scalp, it may cause localized alopecia. Because of maternal hormones, a sebaceous nevus appears more prominent immediately after birth. As the child ages, the lesion thickens and may appear verrucous. Hormonal changes at puberty also make the lesion appear more prominent.1,2

If the diagnosis of sebaceous nevus is unclear, a biopsy may be performed. After puberty, there is a risk of progression to basal cell carcinoma, apocrine carcinoma, or squamous cell carcinoma. Prophylactic excision is usually recommended in late childhood. Patients may have sebaceous nevus syndrome, characterized by a primary lesion and associated cerebral, skeletal, and ocular defects.1,2

Aplasia cutis congenita is a rare congenital disorder that typically affects the vertex of the scalp. It presents as a full absence of skin and possibly underlying structures, such as bone and dura mater.3

A comedo nevus presents as groupings of black, keratinous plugs on the face, neck, upper arms, chest, or abdomen. The lesions predominately occur neonatally but can develop in childhood.4

Neonatal herpes simplex appears as vesicular pustules with surrounding erythema. The vesicles can be found anywhere on the body, most commonly the face, eyes, and mouth. They are usually scattered and may have erosion or crusting.5

In newborns, seborrheic dermatitis (cradle cap) typically presents as yellow, greasy scales on the scalp (cradle cap) or flexures with a “stuck on” appearance.6

Address correspondence to Nicole T. Yedlinsky, MD, at nyedlinsky@kumc.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Moody MN, Landau JM, Goldberg LH. Nevus sebaceous revisited. Pediatr Dermatol. 2012;29(1):15–23....

2. Baigrie D, Troxell T. Nevus sebaceus. StatPearls. Updated November 20, 2020. Accessed February 1, 2021. https://www.statpearls.com/ArticleLibrary/viewarticle/40991

3. Brackenrich J. Aplasia cutis congenita. StatPearls. Updated August 9, 2021. Accessed September 30, 2021. https://www.statpearls.com/ArticleLibrary/viewarticle/17768

4. Brandling-Bennett HA, Morel KD. Epidermal nevi. Pediatr Clin North Am. 2010;57(5):1177–1198.

5. Kimberlin DW. Neonatal herpes simplex infection. Clin Microbiol Rev. 2004;17(1):1–13.

6. Johnson BA, Nunley JR. Treatment of seborrheic dermatitis. Am Fam Physician. 2000;61(9):2703–2710. Accessed September 30, 2021. https://www.aafp.org/afp/2000/0501/p2703.html

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

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