Benign Rashes Various papular rashes may be observed in the healthy newborn Characteristic body distribution patterns and age at appearance help differentiate these rashes from more worrisome conditions Diagnosis can be made by physical examination alone and not require further evaluation or specific treatment Parents should be reassured these are not worrisome conditions Milia are small 1- to 2-mm ivory or yellow papules located primarily on the forehead, nose, and cheeks of newborns Milia are keratin retention cysts They will spontaneously rupture and disappear during the first to weeks of life ( Fig 96.4 ) Miliaria, or neonatal prickly heat, is caused by sweat retention and is characterized by easily ruptured, 1- to 2-mm vesicles located primarily on the face chest and back Erythema toxicum is a more generalized eruption of small papules or pustules on an erythematous base that may occur anywhere on the body Usually presenting during the first to days of life, these lesions may be noted as late as weeks of age If the diagnosis is in question, a smear of the papular contents will show a predominance of eosinophils with no organisms and relative absence of neutrophils ( Fig 96.5 ) Neonatal acne is characterized by erythematous papules or pustules confined primarily to cheeks, chin, and forehead Lesions are caused by circulating maternal hormones, usually appear at to weeks of age and disappear within a few weeks ( Fig 96.6 ) Diaper rash is located on the skin covered by the diaper Irritants and contact dermatitis are often the initial precursor to the rash Candida infections are common and diagnosed if the rash is present in the intertriginous folds Candida infections are beefy red with well-demarcated borders and satellite papules and pustules Mostly a clinical diagnosis, candida can be confirmed if necessary by microscopic examination looking for budding yeasts and pseudohyphae