Concerns about the skin are a common chief complaint during the initial newborn visit in the hospital and the outpatient setting. A recent study of hospitalized neonates found that only 4.3% of the newborns had no dermatological findings. Most newborn skin findings are transient and very rarely require treatment, but it is important to distinguish benign skin lesions from cutaneous manifestations of more serious disorders, such as infections. Therefore, a thorough inspection of the skin for rashes and skin abnormalities is an essential part of the newborn examination.

New parents are often concerned about their baby’s skin. Knowledge and recognition of common, benign lesions of the newborn are important for counseling parents about the natural course of these dermatological lesions.

• A maternal history of primary active genital herpes simplex virus infection perinatally puts the infant at the highest risk of developing herpes neonatorum. A negative maternal history does not exclude the possibility of this diagnosis.

• A history of cyanosis of the hands and feet is often benign, while cyanosis of the lips and mouth is a sign of hypoxia.

• A rare condition involving transient erythema on one half of the body with a sharp demarcation down the midline is called harlequin color change. It is thought to be benign and subsides after the third week of life.

• Physiologic cutis marmorata, a transient rash brought on by exposure to cold or distress, resolves once the baby is warmed.

• Cutis marmorata telangiectatica is always visible.

• Dermal melanocytosis (a.k.a Mongolian spot) is present at birth in more than 90% of African Americans, 80% of Asians, and rarely in Caucasians.

• Pigmentation is first noted in the periungual and genital areas, which will often appear hyperpigmented at birth in dark-skinned newborns.

• The lesions of epidermolysis bullosa heal slowly, whereas sucking blisters often heal within 48 hours.

• Infants who appear ill should have skin lesions cultured to rule out viral, bacterial, or yeast infections.

• Dermal melanocytosis consists of nontender, gray-blue macular lesions primarily located on the lumbosacral area, but may be seen over the entire back and on the shoulders and extremities. Familiarity with these lesions will enable a clinician to distinguish these from ecchymoses.

• Miliaria crystallina are pinpoint vesicles containing clear fluid. The lesions are easily denuded with pressure.

• The lesions of erythema toxicum, the most common transient rash in healthy term newborns, are often absent at birth and will often appear during the first few days of life.

• Erythema toxicum spares the palms and soles, while clusters of pustular melanosis may appear on pressure areas.

• Pustular melanosis may present at birth with small hyperpigmented macular lesions if the pustular phase occurred in utero.

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