Differential Diagnosis for Skin-Colored Papules on the Face of a 2-Month-Old

Single Most Likely Diagnosis

• Milia: These are small, white or skin-colored bumps that appear on the skin of many infants. They occur when dead skin cells or keratin, a protein, get trapped under the skin surface. Given the age of the patient and the description of the lesions, milia are a common and benign condition that fits well.

Other Likely Diagnoses

• Erythema Toxicum Neonatorum (ETN): Although ETN typically presents at birth or shortly after, some cases may persist or appear slightly later. It's characterized by small, yellowish or skin-colored bumps on a red base. However, ETN usually resolves on its own within the first week or two of life.
• Baby Acne (Neonatal Acne): This condition can cause small, skin-colored or red bumps on the face, especially on the cheeks, nose, and forehead. It's thought to be caused by exposure to maternal hormones before birth.
• Sebaceous Hyperplasia: These are small, benign growths that can appear as skin-colored papules on the face. They are due to an increase in the size of the oil-producing sebaceous glands.

Do Not Miss Diagnoses

• Congenital Syphilis: Although less common, congenital syphilis can cause a variety of skin manifestations, including papules. Given the potential severity of untreated syphilis, it's crucial to consider this diagnosis, especially if other signs or risk factors are present.
• Infantile Acropustulosis: This rare condition causes itchy, blister-like bumps that can appear on the face and extremities. It's essential to distinguish it from other conditions due to its potential for discomfort and the need for specific treatment.

Rare Diagnoses

• Langerhans Cell Histiocytosis (LCH): A rare disorder in which the body accumulates too many immature Langerhans cells, part of the immune system. Skin lesions can be one of the manifestations, although it's much less common in infants to present solely with skin-colored papules on the face.
• Xanthomas: These are rare, benign growths composed of fat-laden cells that can appear as yellowish or skin-colored papules. They are less common in infants and usually associated with lipid disorders, which would be unusual at this age.