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

Aashir S. Siddique, BSc
Michelle L. Gallagher, DO
Volume 63 - Issue 10 - October 2023

  • AFFILIATIONS:
    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).

    2-month old infant

    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.
     

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