Transitory Skin Changes in Newborns

Introduction and umbilical involution

Transitory states reflect the physiological adaptation of the body to new environmental factors. These changes affect not only the skin, but also mucous membranes and internal organs. Under favorable conditions, they are entirely normal. However, under the influence of adverse triggers, such as prematurity, pathological labor and pregnancy, or feeding disorders, these conditions can become the basis for the development of actual diseases.

Such natural processes also include the involution of the umbilical cord. Normally, the umbilical residue falls off on days 4–5, and complete epithelialization (healing) of the umbilical wound is completed by the end of the second week of life.

Simple erythema (erythema neonatorum simplex)

Simple erythema is a reactive hyperemia in response to new stimuli: temperature changes, exposure to air and light.

• Clinical presentation: The newborn's skin becomes diffusely red, while body temperature and the child's general well-being remain unaffected.
• Dynamics: Redness persists for 2–3 days and disappears spontaneously, without interventions, by the end of the first week of life.

Risk groups. In premature infants, as well as newborns from mothers with diabetes mellitus, simple erythema has a protracted course and may persist for up to 2–3 weeks. In these cases, the process ends with pronounced fine- or large-lamellar desquamation, which is most prominent on the palms and soles. This is also normal and requires no treatment.

Toxic erythema of newborns

This condition is registered in 25–30% of infants and manifests on days 2–5 of life. Pathogenetically, it is considered an allergic reaction to breast milk proteins (which is confirmed by concomitant blood eosinophilia) or the result of enteral autointoxication.

• Morphology of the rash: Grayish-yellow papules or vesicles form against the background of erythematous spots. The exudate inside these elements is rich in eosinophils.
• Localization: The rash is grouped on the chest, buttocks, and around the joints. Key differential diagnostic sign: elements never appear on the palms, soles, and mucous membranes.
• Course: Elements can be solitary or confluent. The rash usually disappears without a trace in 2–3 days, but wave-like relapses are possible throughout the first month.

In an uncomplicated course, therapy is not indicated. However, with generalized, abundant rashes, the risk of secondary infection increases, which justifies the prescription of antihistamines.

Milia and physiological desquamation

Milia (Milia) are pinpoint white-yellow formations the size of a pinhead, outwardly resembling vesicles. They are located in isolation or in small groups on the face (mainly on the forehead and tip of the nose). Essentially, they are retention cysts resulting from blockage of the excretory ducts of sebaceous glands, whose function activates in the final weeks of gestation. Milia regress spontaneously within 1–2 weeks without any treatment.

Physiological desquamation of the skin manifests in the first days of life. It can be fine- or large-lamellar. It is important to note that large-lamellar desquamation localized on the chest and abdomen is a typical sign of fetal post-term maturation. Like other transitory states, it requires no therapeutic intervention.

Caput succedaneum (Caput succedaneum)

Caput succedaneum is a local edema of the soft tissues of the presenting part of the fetus, which forms during the passage through the birth canal.

Fine punctate hemorrhagic elements (petechiae) may be detected in the area of edema. This condition is strictly transitory and resolves without a trace within 1–2 days without the use of any medications.

Class and exam questions

What else to study on this topic

• Differential diagnosis of toxic erythema and neonatal pyoderma
• Pathogenesis of enteral autointoxication in the early neonatal period
• Influence of maternal diabetes mellitus on the timing of simple erythema involution
• Differential diagnosis of caput succedaneum and cephalhematoma
• Adaptation mechanisms of fetal sebaceous glands in the final weeks of gestation

Other topics in «Chapter 2. Neonatology»

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.