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Causes of neonatal skin discoloration Colour Other causes of colour change in the skin are listed in Table 2. For more details on birthmarks see the article by Ryan and Warren in this issue of Australian Family Physician. 4,5 Melanocytic naevi that are medium to large or involve cosmetically sensitive areas should be referred for specialist management. with beta blockers) and giant congenital melanocytic naevi (with early curettage) may be very narrow. Appropriate referral and follow up is critical as the window of opportunity to treat haemangiomas (eg. Neonatal birthmarks can be easily misdiagnosed: hemangiomas can resemble port wine stains, while early congenital melanocytic naevi may resemble café au lait macules. It may lighten with vascular laser treatment. Cutis mamorata telangiectatica congenita is a fixed vascular change associated with subtle dermal atrophy and sometimes, limb length discrepancy, which can be part of a syndrome. Reticulated (livedoid) purplish mottling of the skin may represent physiological capillary and venular dilatation accentuated by cold (cutis mamorata), but may persist pathologically (Trisomies 18 and 21, Cornelia de Lange). It presents in the first 3 weeks of life, usually days 2–5, as a result of hypothalamic immaturity, and is more common in prematurity and intracranial injury. Harlequin colour change, presenting as reddening of the lower half and pallor of the upper half of a baby lying on the side, lasts for several minutes.

Toxoplasmosis, rubella, cytomegalovirus, herpes.Adams-Oliver syndrome with limb anomalies.chromosomal anomalies (Patau, Wolf-Hirshhorn), Delleman, Finlay-Mark, Goltz, Johnson-Blizzard, Kabuki, Setleis 3 Children with aplasia cutis, where there is localised absence of intact skin at birth, should be referred for specialist assessment. Other causes of aplasia cutis are listed in Table 1, and when associated with glistening 'membranous' changes or a 'hair collar', there may be other neural tube defects. pits, dimples), anetoderma (localised loss of elastic tissue presenting as a soft protuberance), bleeding, infection, calcified nodules and aplasia cutis (absence of skin). Iatrogenic trauma can also cause scarring (eg. Trauma at birth may give rise to a boggy scalp mass from oedema and venous congestion (caput succadaneum) or a subperiosteal haematoma (cephalohematoma), the latter limited to one cranial bone and possibly associated with an underlying fracture, secondary hyperbilirubinaemia, calcification and infection. Colour usually rapidly becomes pink apart from the hands, feet and lips, where an initial dusky acrocyanosis may occur as a result of increased vascular tone. Desquamation on day one may represent intrauterine anoxia or a disorder of keratinisation (ichthyosis).

Desquamation is usually delayed, occurring between 24 hours and 3 weeks, earlier in term than premature babies. Neonatal skin is usually soft and smooth, covered with vernix caseosa, a derivative of sebaceous secretion and decomposing epidermal cells.

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