Dr. Erin Mathes presented cases that demonstrate neonatal cutaneous processes, including erythroderma, infantile hemangiomas (IH) in preterm infants, solitary infantile myofibromas (IM), infantile malignancies, transverse nasal root veins, and newborn telangiectasias. She highlighted clinical practice gaps and areas for future research.
First, Mathes discussed neonatal erythroderma. The differential diagnosis ranges from life-threatening diseases (e.g., severe combined immunodeficiency [SCID]) to benign processes (e.g., atopic dermatitis, seborrheic dermatitis). A full-body rash or blisters in a newborn infant is a medical emergency.
Mathes described an algorithm for evaluating neonatal erythroderma. Dermatologists should perform a physical exam and consider morphology in the differential diagnosis. Alopecia may indicate a primary immunodeficiency; the dermatologist should check the results of the T cell receptor excision circle (TREC) test on the universal newborn screening panel. TREC levels can indicate impaired T cell development associated with SCID. A collodion membrane may indicate ichthyoses that can be confirmed with a genetic testing panel. Pustules or vesicles may indicate infection (e.g., congenital cutaneous candidiasis) and should be cultured. Bullae or blisters should be biopsied for evidence of epidermolytic ichthyosis, staphylococcal scalded skin syndrome, or diffuse cutaneous mastocytosis.
Second, Mathes discussed IH in preterm infants. Research suggests that preterm infants are more likely to have thick, localized IH with a stepped border; these characteristics increase the risk for skin sequelae. Propranolol can be used safely in preterm infants in a monitored setting but may cause more complications and require more treatment modifications than in full-term infants. Dermatologists should consider early treatment with propranolol to prevent disfigurement in preterm infants with IH.
Third, Mathes described the clinical presentation and screening recommendations for solitary IMs and infantile malignancies. Solitary IMs are associated with variations in the PDGFRB, NOTCH3 and SRF genes. Solitary and multicentric IMs typically resolve without additional complications. Generalized IMs with visceral involvement are rare but have a high mortality rate. Additional screening should be offered to families with an infant with solitary IM to rule out visceral involvement. Screening may include a chest x-ray, echocardiogram, and a whole-body MRI with and without contrast with repeat physical exams every 3-6 months.
Infantile malignancies are rare but do occur. Risk factors for malignancy in infants with superficial lumps include neonatal onset, rapid or progressive growth, skin ulceration, location in the deep fascia, firmness to the touch, and a diameter greater than 3 cm. These factors are sensitive but not specific for malignancy. For suspected malignancy, the goal of a biopsy is to achieve clinical-pathologic correlation.
Finally, Mathes discussed transverse nasal root veins and newborn telangiectasias, usually benign conditions that may be concerning for parents. Transverse nasal root veins are normal and not a sign of an underlying vascular anomaly or veinous disease. Transient abdominal telangiectasia in newborns presents at age 1-20 days and is usually benign. Signs of a more severe process include persistent abdominal distention, a taught abdomen, decreased bowel sounds, vomiting, and other signs of illness.
Join us for 2026 DF Clinical Symposium, January 28–31. Register today!