Mr Yaron Gu ( left ) Medical student , UNSW Sydney ; department of dermatology , Liverpool Hospital , Sydney , NSW .

Associate Professor Deshan

Sebaratnam ( right ) Staff specialist , department of dermatology , Liverpool Hospital ; Conjoint Associate Professor , UNSW Sydney , NSW .

Conflicts of interest Deshan Sebaratnam has received consulting fees from Galderma , AbbVie , Pfizer , Novartis , Janssen , Leo Pharma , Ego Pharmaceuticals , Sun Pharma , Viatris , a scholarship from Eli Lilly and material support from Candela Medical . Yaron Gu has no conflicts to report .

Copyright © 2023 Australian Doctor All rights reserved . No part of this publication may be reproduced , distributed , or transmitted in any form or by any means without the prior written permission of the publisher . For permission requests , email : howtotreat @ adg . com . au .

This information was correct at the time of publication : 1 September 2023

INTRODUCTION

NEONATAL skin is unique , and

rashes are common during infancy . Most of the time , these dermatological changes represent benign , transitory conditions , but they may also forewarn serious medical problems or genetic diseases . Common morphologies in neonatal rashes include scaly skin , blistering rashes , vascular anomalies and colour changes .

This How to Treat provides an overview of the clinical presentation of common skin rashes in neonates and aims to ensure that GPs can confidently manage common conditions and recognise when to refer .

SCALY RASHES

Eczema

ATOPIC dermatitis or eczema is the

most common inflammatory skin condition worldwide , affecting up to 30 % of Australian children . 1 Eczema presents with erythematous , scaly plaques , sometimes with weeping or crusted lesions ( see figure 1 ). 2 , 3 Papules and vesicles may also be present . The nappy region is often spared because of moisture retention from nappies . The distribution of lesions changes throughout development ,

with extensor involvement in crawling infants and more flexural involvement in walking children . Risk factors include a family history of atopy ( atopic dermatitis , asthma , allergic rhinitis and food allergy ) and variants in the filaggrin gene . 4-7 Complications include concomitant infections with Staphylococcus or Streptococcus spp ., molluscum contagiosum , eczema herpeticum or eczema coxsackium . 8-10 Hyper- and hypopigmentation may occur in patients with skin of colour . 11

The diagnosis of atopic dermatitis is usually made clinically . Advise patients there is no cure , and that the goal of management is symptom control . Emollients are an essential aspect of management , with high oil / low water mixtures ideal for barrier repair . Apply topical steroids liberally once per day to any areas of the skin that are erythematous , pruritic

12 , 13 or scaly until clearance is achieved . The recommendation to ‘ use sparingly ’ is not supported by the literature . 14 Prescribe authority scripts for topical steroids routinely to aid compliance , prescribed depending on the surface area involvement . Topical calcineurin inhibitors are preferred for treatment of eczema of the eyelids ,

neck and skin folds . 13 Crisaborole 2 % ointment twice daily is a new eczema treatment recently introduced into Australia and is TGA approved for use in patients from two years of age with mild to moderate atopic dermatitis . An example of a treatment regimen for eczema is twice daily application of a bland emollient ( such as QV Intensive Cream , CeraVe Moisturising Cream , Dermeze or Cetaphil moisturiser ) two to three times daily all over . For other affected areas , apply methylprednisolone aceponate fatty ointment once daily prn to the face , pimecrolimus 1 % cream twice daily prn for the eyelids and betamethasone dipropionate ointment 0.05 % once daily prn to the body .

Rarely , eczema may be a presenting sign of immunodeficiency . Red flags that may indicate immunodeficiency include faltering growth , developmental delay , recurrent infections , adverse reactions to immunisations and a family history of consanguinity .

Psoriasis

Psoriasis has an estimated prevalence of up to 1.4 % in children . 15 The two most common morphologies found in children are plaque

and guttate psoriasis . 16 Plaque psoriasis appears as erythematous , well-demarcated plaques with a silvery-white scale , while guttate psoriasis is characterised by small ‘ rain drop ’ papules ( see figure 2 ). 17 Nail changes such as pitting or onycholysis are present in up to 10 % of infants . 16

The diagnosis of psoriasis is typically made clinically . For mild disease , emollients and topical corticosteroids as monotherapy or in combination with vitamin D analogues may be sufficient for disease control . 18 A similar regimen may be employed to that used in eczema .

Scabies

Scabies is a common infectious skin disease caused by the ectoparasitic mite Sarcoptes scabiei var . hominis . The presentation of scabies in infants includes a generalised vesiculopapular eruption with lesions typically found on the palms , soles ,

19 , 20 neck , axilla and head ( see figure 3 ). Infants may present with irritability , insomnia and poor feeding . Hypersensitivity nodules may develop at the elbows , axillae , penis and scrotum and may persist for months .

Definitive diagnosis is based on