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What Are These Multiple Papules on a 2-Month-Old’s Face?

Aashir S. Siddique, BSc1 • Michelle L. Gallagher, DO2

    1College of Osteopathic Medicine, Michigan State University, Macomb, MI
    2Assistant Professor, Department of Pediatrics, College of Osteopathic Medicine, Michigan State University, Macomb, MI

    A 2-month-old infant presented to the clinic with diffuse small pustules and papules localized on the scalp, face, shoulders, and back (Figures 1 & 2).

    Figure 1

    Figure 1. Frontal view of diffuse small pustular and papular lesions on a 2-year-old infant, showing monomorphic pustules and papules localized to the face and scalp. Mild erythema is present on cheeks. Infant appears to be in mild distress, but otherwise attentive and stable.

    figure 2

    Figure 2. Lateral view of the infant, showing that the cutaneous lesions also extend to the scalp, ears, and shoulders. No visible comedones or vesicles were present throughout.

    History. The mother believed that the rash appeared approximately 4 weeks ago and gradually worsened over time. The lesions were monomorphic and appeared to be along the same stage of development. There were no comedones, nodulocystic lesions, or vesicles. Some erythema was present, but it was difficult to appreciate on the darker pigmented skin. No constitutional symptoms, including fever, were present at the time of examination, and the infant was alert and interactive. However, the mother stated that the infant seemed to be uncomfortable, possibly itchy, but that was difficult to discern because of his age. The mother reported an uncomplicated pregnancy and denied using any topical oils or medications on the infant.

    Diagnostic testing. A diagnosis was made based on exclusion by carefully analyzing lesion appearance and his clinical history.


1. Reginatto FP, Villa DD, Cestari TF. Benign skin disease with pustules in the newborn. An Bras Dermatol. 2016;91(2):124-134. doi:10.1590/abd1806-4841.20164285

2. Ghosh S. Neonatal pustular dermatosis: an overview. Indian J Dermatol. 2015;60(2):211. doi:10.4103/0019-5154.152558

3. Kutlubay Z, Tanakol A, Engýn B, et al. Newborn skin: common skin problems. Maedica (Bucur). 2017;12(1):42-47.

4. Fimiani M, Bilenchi R, Mandato F, et al. Neonatal skin disorders. Neonatology. 2018:2391-2425. doi:10.1007/978-3-319-29489-6_285

5. Chadha A, Jahnke M. Common neonatal rashes. Pediatr Ann. 2019;48(1):e16-e22.


6. Greydanus D, Azmeh R, Demma M, Dickson C, Patel D. Acne in the first three decades of life: an update of a disorder with profound implications for all decades of life. Dis Mon. 2021;67(4):101103. doi:10.1016/j.disamonth.2020.101103

7. Paller AS, Mancini AJ. Hurwitz Clinical Pediatric Dermatology. 6th ed. Elsevier; 2020:11-41.

8. Levy HL, Cothran F. Erythema toxicum neonatorum present at birth. Am J D Child. 1962;103(4):617-619. doi:10.1001/archpedi.1962.02080020630014

9. Marchini G, Nelson A, Edner J, Lonne-Rahm S, Stavréus-Evers A, Hultenby K. Erythema toxicum neonatorum is an innate immune response to commensal microbes penetrated into the skin of the newborn infant. Pediatr Res. 2005;58(3):613-616. doi:10.1203/01.pdr.0000176836.27156.32

10. Jain AK, Morgaonkar M. Acne in childhood: clinical presentation, evaluation and treatment. Indian J Paediatr Dermatol. 2015;16(1):1-4. doi:10.4103/2319-7250.149399

11. Bernier V, Weill FX, Hirigoyen V, et al. Skin colonization by Malassezia species in neonates: a prospective study and relationship with neonatal cephalic pustulosis. Arch Dermatol. 2002;138(2):215-218. doi:10.1001/archderm.138.2.215