Neonatal Dermatology Case Review: Newborn Skin Eruptions, Infantile Hemangioma, and Aplasia Cutis Congenita

The talk reviewed neonatal dermatology through three hospital consult cases and key clinical principles. It first explained that neonatal skin is thinner, more fragile, and more prone to injury, medication absorption, and infection, so newborn rashes must be approached by considering normal transient eruptions, infection, birthmarks, and congenital defects. The first case was a two-day-old infant with a sudden pustular rash on the buttock, ultimately diagnosed as neonatal miliaria pustulosa after bacterial and HSV cultures were negative and the lesions resolved spontaneously within 36 hours; the speaker emphasized ruling out dangerous infections like HSV and candidiasis before settling on a benign diagnosis. The second case involved a two-week-old infant with bilateral facial swelling and a segmental infantile hemangioma in an S3 facial distribution with parotid involvement. Because segmental hemangiomas can be associated with PHACE syndrome and airway hemangiomas, the infant underwent MRI/MRA, echocardiography, ophthalmologic evaluation, and ENT laryngoscopy; all were normal. He was treated with propranolol, later required sirolimus because the deep component and swelling worsened, and his coagulopathy improved. The speaker discussed hemangioma classification, screening indications, propranolol dosing, and when to suspect airway involvement. The final case was a newborn with shallow vertex scalp ulcerations present at birth, diagnosed as aplasia cutis congenita. The talk reviewed when to image for associated skull or brain defects based on lesion size, midline location, hair collar sign, or other concerning features; this infant’s ultrasound was normal, supporting isolated aplasia cutis congenita managed with reassurance and wound care.