Pediatric Dermatology and Genodermatoses
Neonatal skin
Erythema toxicum neonatorum, transient neonatal pustular melanosis, milia, and seborrheic dermatitis are benign. Distinguish from staphylococcal pustulosis and herpes simplex, which require urgent evaluation.
Genodermatoses
Neurofibromatosis type 1 (café-au-lait, axillary freckling, neurofibromas), tuberous sclerosis (ash-leaf macules, angiofibromas, seizures), ichthyoses (filaggrin, transglutaminase), epidermolysis bullosa subtypes (simplex, junctional, dystrophic), and incontinentia pigmenti (X-linked, Blaschkoid stages).
Inflammatory and infectious
Atopic dermatitis, diaper dermatitis (irritant vs Candida), molluscum, and hand-foot-and-mouth disease. Kawasaki disease presents with fever, mucositis, rash, and desquamation; recognize early to prevent coronary complications.
Traps
- Missing Kawasaki because rash is nonspecific; apply diagnostic criteria.
- Confusing neonatal pustular melanosis with infection; smears show neutrophils/eosinophils, not organisms.
- Overlooking tuberous sclerosis when only seizures are reported.
Rule of thumb
In a neonate with pustules, ask: fever/systemic illness (infection workup) vs well-appearing (benign pustulosis).
Worked example
A 5-day-old with fever, mucositis, and polymorphous rash: suspect Kawasaki; obtain echocardiogram and start IVIG plus aspirin.