What are the characteristics of a newborn’s skin?
There are changes in the skin of newborns that upset parents. Most of them are harmless and withdraw on their own but there are also those that require treatment. The most common are infections and congenital malformations in the skin structure, which are also the most common changes in the skin in the newborn.
During the period of embryonic development, the child goes through many stressful events. This also refers to the largest organ in the human body on the skin. At birth, the newborn’s skin changes from an intauterine, warm and moist milieu to a dry, cold and non-sterile environment, with specific skin changes and skin diseases of the newborn period.
Table 1 shows a differential diagnostic overview of changes in the skin of the newborn:
Table 1 differential diagnosis of skin changes in newborns: | ||
Leits symptom | As a rule, harmlesschanges in the skin | Skin changes that require therapeutic treatment |
Changes that have a papule and a pustule | Milien Miliaria Erythema toxicum neonatorum Acne neonatorum Transient neonatal pustulosis Melanose | Bacterial impetigo Candiodza, Scabies Incontinentia pigments Langerhanszell-Histiozytose Acrodermatitis enteropatica / Zinkmangeldermatitis |
Skin discoloration and tumors | Melanocyte nevus (“Muttermal”) Mongolian spot Naevus flammeus (Feuermal) Hemangioma Warts on the chest Aplasia of the congenital cortex Dermoid cyst | |
Bladder changes | Bacterial impetigo Herpes neonetorum Congenital chickenpox Staphylococcus scaled skin syndrome Hereditary epidermolysis Bullous mastocytosis | |
Changes in which flaking is observed | Seborrheic eczema | Ichthyosis Tinea (fungi) |
What forms of transient harmless changes exist?
Most of these skin changes in newborns are physiological in nature and are called Milie. They are transient and have no characteristic of a diseased condition. Transient vascular disorders, hormonal changes, and immature skin glands are the cause of these changes in the skin.
Mention should be made of neonatal infectiousskin diseases caused by staphylococci, streptococci and candida, and conatal infections caused by herpes simplex, redness, chickenpox and syphilis.
Systemic diseases such as neonatal lupus erythematosus sometimes occur.
What changes of that age are marked by redness of the skin?
1. Cutis marmorata (marbled skin) occurs in the cold and is characterized by reticulate, bluish-streaked skin. It usually appears as a harmless reaction of dilation of blood vessels that is lost during growth, but still, it is necessary to warn of small microbleeds in the skin, such as. in the first sepsis and caution is required with such changes.

2. Harlequin changes in the skin
Harlequin changes occur in 10% of newborns including vascular disorders and are manifested by alternating severe redness and whitening of the posterior upper half of the trunk that lasts an average of one second to one minute. Over time, the change recedes spontaneously.
What changes are marked by papules and pustules:
Miles
are caused by the impurity of the sebaceous glands. Approximately 50% of newborns have milia as white small papules 12 mm in diameter in the facial area. Miles are small epidermal cysts of the sebaceous glands. They are most often present at birth or develop during the first month of life, and recede as early as the first week of life. Similar lesions can appear in the area of the hard palate and are then called Epstain perlen.
Millionaire
Very frequent changes in the miliaria are caused by the movement of sweat glands by metabolism in the skin, tiny superficial vesicles and red papulovesicles. Overheating and sweating of children should be avoided here.
What are Acne neonatorum
In 20% of newborns, they develop at birth or within the first two to four weeks of life. They appear as papules, pustules and closed comedones (blackheads) on the forehead, face and nose. Acne occurs as a result of maternal androgen stimulation, sebaceous gland hyperplasia, colonization of the skin by the yeast fungus Pytirosporum ovale. As a rule, therapy is not demanding. In more severe or persistent cases, careful topical treatment with benzoyl peroxide may be attempted.

Erythema toxicum neonatorum! Is that something dangerous?
The most common skin disease in which a purulent blister is visible on the skin is a disease that lasts two to three days and is visible on the trunk, face and limbs. The disease is manifested by pimples and water bubbles on a red background that later turn into a purulent blister. No changes were observed on the palms and soles of the feet. The changes disappear spontaneously after a few days. The exact cause of the disease is unclear, but it is assumed that the rest of the immune system is activated. Similarity with Erythema toxicum neonatorum is shown by Candida albicans and Staphylococcal infections in which purulent blisters are also visible on the skin.

The changes marked by the formation of blisters on the skin are as follows?
Soft bladder changes: Occasionally found in children at birth on the fingersor wristsharply isolated and demarcated and withdraw on their own. There are also rare diseases of bladder formations. The appearance of multiple blisters and unnatural skin damage are characteristic of hereditary diseases of bladder formations such as bullous epidermolysis. If large areas of skin are affected by blisters and erosions, we are talking about a disease called Staphylococcal – Scal syndrome (SSS syndrome).
We have noticed that in some diseases the skin is scaly. What are these diseases?
Characteristics of Ichthyosis, Palmolantar keratosis, Erythrokeratodermaare the upper layers of the skin affected by the scales. Different diseases with different clinical pictures are distinguished here. The clinical picture ranges from fine to coarse lamellar rhomboidal scales to severe clinical pictures of diseases such as e.g. – HarleqiniColodium baby.

Can moles be divided?
Moles are divided into pigmentedand vascular(caused by dilation of blood vessels). They in turn are divided into subclasses such asMelanocyte moles, Hemangiomas,Nevus flameus or Mongolian spot. Although the parents of such children are upset, they are mostly harmless and do not need to be treated (unless they are large melanocyte moles or hemangiomas located at the site in question). The earlier you start cosmetic treatment, the better it is. It is also important to identify lesions that are associated with deformities such as spina bifida and manifest in the form of hidden or vascular formations.
The red congenital vascular mole is called Hemangioma. About 2% -10% of newborns show bright red changes a day to a week after birth. When a hemangioma grows as a vascular tumor it can cause changes in sensation. It can be localized cutaneously or subcutaneously to grow within the first month of life and then partially or partially withdraw in the first 5 or 10 years of life.

What is the tendency of hemangiomas to self-destruct:
It begins after only 6 months with the appearance of central pale islets and results in the collapse of the hemangioma. After withdrawal, scars with atrophy, telangiectasias, and hypopigmentation may remain. The spontaneous tendency of organ deterioration can be stimulated by contact cryotherapy (freezing with liquid nitrogen) or laser therapy. In non-problematic localizations such as the trunk and extremities, hemangiomas may develop spontaneously and be controlled.
What if the hemangioma is inconveniently localized?
Hemangiomas are tufts of extra blood vessels that commonly occur in certain areas (eyelids, mouth, airways) or in painful ulcers. In this case, therapeutic indications are necessary and consist of central intralesional laser therapy, systemic glucocorticoids or excision.
Can multiple hemangiomas damage internal organs?
Very rarely, high blood pressure from large multiple hemangiomas can overload the heart. Diffuse neonatal hemangiomatosis occurs in multiple small hemangiomas of the body. Hemangiomas are more likely to be present at 50% of the internal organs, but this is also very rare.
What is Naevus flameus?
In these light red to blue-red moles, skin changes are already present at birth. Redness originates from the capillaries of the skin’s smallest blood vessels. It is necessary to distinguish between medial and lateral Naevus flameus.

What are the features of the medial Naevus flameus:
It is harmless and is found mainly on the skin of the neck. In the case of a flameus nevus localized in this area, as a rule, self-deterioration is not to be expected, as well as at the root of the neck and above the eyebrows. The decay of nevi in other localizations is mostly within the second year of life.
Lateral Naevus flameus:
disappears with the disappearance of capillaries during child development. Over time, the intensity of the color increases, nodular parts are formed which, for cosmetic reasons, can be removed very early with laser therapy (within the first year of life).
Pigmented spots:
What are congenital melanocyte moles:
Congenital melanocyte moles occur in 0.2% to 2% of newborns. These are mostly small brown moles up to 30mm in diameter (large ones mostly come in old age). It is evenly pigmented and has hair. At that age, medium-sized (3-10cm) and large congenital moles (15cm) are also noticed, which are called nevus bathing suits or large congenital nevus (Tirfelnevus) due to their appearance.
What is the risk of developing melanoma in such moles?
Small and medium-sized congenital moles are evaluated, judged differently in the literature, and appear to occur in 1-5% of all moles of that age. It is usually recommended to excise such small and medium congenital moles as early as possible. Based on the later size of these moles and the reduced elasticity of adult skin, it is best to remove moles within the first month of life, and best within the first year of life. With rare large congenital moles that extend deep into all layers of the skin, there is a risk of malignant alterations.
What is a Mongolian spot:
Dermal melanoses as Mongolian spots are formed by the accumulation of pigment cells (melanocytes) in the deep layers of the skin that appear clinically as blue-gray spotsmostly on the skin of the sacrum, sacrum, and is present especially in Asian and colored newborns. They are harmless and recede within the first year of life. The development of malignant melanomas on Mongolian spots is unknown.

What are the congenital defects in skin development:
Ear pendants
These are skin discolorations, pimples and purulent blisters on the outside of the ear that appear mostly unilaterally and isolated through developmental disorders and manifest as a hanging band, a pendulum.
Excessive warts
In about 1-2% of newborns, there are excessive nipples (accessory nipples) as the rest of the embryonic mammary gland. The chest or upper abdomen is affected unilaterally. Only in cosmetic truncations or continued growth during puberty is excision recommended.
Cutis congenita aplasia
They come at birth in the form of a round or oval yellowish or reddish-brown indentation or a reddish-brown scar. It mostly affects the hair on the head, but also on the torso and extremities. Skin changes occur singly or multiple. They may be superficial but may extend to the meningeal sheaths. Ulcerations are possible. Excision is usually required for cosmetic damage.

What are the hidden congenital skin defects?
There are lesions that are hidden and may indicate some defect in the spine. Some to look out for are: Hidden dimples on the cheeks, fistulas, lipomas, localized hypertrichosis (excessive body hair) and pigment spots. The lesions are located in the area of the dorsal midline around the spine and sacral and require further diagnosis.

Keywords: Newborn skin, milia, hemangioma, moles, Acne neonatorum, hypertrichosis
In short: Changes in the skin of newborns are mostly harmless in nature and recede on their own. They most often manifest in the form of infections and congenital malformations in the skin structure.
Did you knowthat cow’s milk is the most common nutritional allergen in children and adolescents. According to a study by Gazi University, Faculty of Medicine, Department of Pediatrics and Neonatology in Ankara (Turkey), food allergy is defined as an adverse clinical reaction due to an abnormal immune response. Among 140 food products, the most common are reactions to cow’s milk, chicken eggs and legumes, especially peanuts.
For My doctor: Perica Ante dr.med. dermatovenerologist