A 2-week-old neonate develops yellowish-white papules on the nose, cheeks, and chin. The lesions are 1–2 mm, firm, and non-inflammatory. They resolve spontaneously within 4–8 weeks without treatment. What is this condition and what is its dermatopathological basis?
- A Milia — retention cysts of vellus hair follicles filled with keratin ✓
- B Neonatal acne — Malassezia-driven follicular inflammation
- C Erythema toxicum neonatorum — eosinophil-filled follicular pustules
- D Transient neonatal pustular melanosis — subcorneal pustules with neutrophils
Explanation
Milia are tiny epidermal inclusion cysts (retention cysts) arising from occlusion and keratin accumulation within vellus hair follicles or eccrine ducts, appearing as firm, pearly-white 1–2 mm papules predominantly on the nose, cheeks, chin, and forehead of neonates (primary milia). They are asymptomatic and self-resolve within weeks to months as the hair follicle opens. Neonatal acne presents with comedones and inflammatory papules. Erythema toxicum neonatorum has erythematous macules/papules with central pustules and eosinophils on Tzanck smear. Transient neonatal pustular melanosis is more common in darker-skinned neonates, leaves hyperpigmented macules after pustule resolution.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.