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Newborn Skin: Part I. Common Rashes and Skin Changes
Mar 2024
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Newborn Skin: Part II. Birthmarks

Katherine A. M. Snyder, MD
Adam D. Voelckers, MD

American Family Physician. 2024;109(3):217-221.

Author disclosure: No relevant financial relationships.

This is part II of a two-part article on newborn skin. “Newborn Skin: Part I. Common Rashes and Skin Changes,” appears in this issue of AFP.

Birthmarks in newborns can be classified as vascular, melanocytic or pigmented, or markers of underlying developmental abnormalities of the nervous system. A nevus simplex is a benign capillary malformation. Newborns with a nevus flammeus can be safely treated before one year of age with a pulsed dye laser to reduce the visibility of lesions. Infantile hemangiomas should be treated with systemic beta blockers if there is a risk of life-threatening complications, functional impairment, ulceration, underlying abnormalities, permanent scarring, or alteration of anatomic landmarks. Dermal melanocytosis is a benign finding that is easily recognized and does not warrant further evaluation. A solitary congenital melanocytic nevus that is less than 20 cm in diameter may be observed in primary care; children with larger or multiple nevi should be referred to pediatric dermatology due to the risk of melanoma. Newborns with skin markers of occult spinal dysraphism (other than a simple, solitary dimple) should have lumbar spine imaging using ultrasonography or magnetic resonance imaging.

Birthmarks are common sources of parental concern, and some require evaluation and treatment. Birthmarks can be classified as vascular, as melanocytic or pigmented, or as markers of underlying developmental abnormalities of the nervous system. Part II of this article reviews the identification and management of birthmarks that appear in the neonatal period, with an emphasis on prognosis and appropriate counseling for parents. Part I of this article, which also appears in this issue of American Family Physician, discusses the presentation, prognosis, and treatment of common rashes and skin changes that may present during an infant's first four weeks of life.1

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating Comments
Newborns with a nevus flammeus that involves the forehead should be referred for ophthalmologic and neurologic evaluations.4 C Expert consensus statement
For infantile hemangiomas that have high-risk features, propranolol at a dosage of 2 to 3 mg per kg per day is the most effective treatment.10,15 A Cochrane review
Patients with a solitary congenital melanocytic nevus with a projected size of greater than 20 cm in any dimension or multiple congenital melanocytic nevi of any size should be referred to dermatology.18 C Expert opinion
Newborns with lumbosacral findings such as hypertrichosis, hemangiomas, or a subcutaneous mass (e.g., lipoma) or caudal appendage, and those with multiple lumbosacral skin abnormalities should be evaluated for occult spinal dysraphism with ultrasonography or magnetic resonance imaging.21,23–25 B Prospective and retrospective clinical case reviews and a cost-effectiveness analysis model
Newborns with a solitary, atypical lumbosacral dimple should be evaluated for occult spinal dysraphism using ultrasonography.21,23–25 B Prospective and retrospective clinical case reviews and a cost-effectiveness analysis model

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

KATHERINE A. M. SNYDER, MD, is a staff physician and the clinical medical director at Mosaic Community Health–Madras (Ore.) Health Center.

ADAM D. VOELCKERS, MD, is a faculty physician at the University of Pittsburgh Medical Center, Lititz (Pa.) Family Medicine Residency Program.

Address correspondence to Katherine A. M. Snyder, MD, Mosaic Community Health, 500 NE A St. Ste. 100, Madras, OR 97741 (katie.snyder@mosaicmedical.org). Reprints are not available from the authors.

Author disclosure: No relevant financial relationships.

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Mar 2024
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