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Differential Diagnosis for Discrete, Smooth, Flesh-Colored, Dome-Shaped Papules in Infants <12 Months

Single Most Likely Diagnosis

  • Milia: These are small, white or flesh-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 description of discrete, smooth, flesh-colored, dome-shaped papules, milia are a common and likely diagnosis in infants under 12 months.

Other Likely Diagnoses

  • Syringomas: These are benign growths that can appear as small, flesh-colored or yellowish bumps on the skin, often around the eyes but can occur elsewhere. They are more common in females and can start appearing in infancy.
  • Eccrine Poroma: A rare benign adnexal tumor that can present as a small, dome-shaped papule. Though less common, it's a consideration in the differential for flesh-colored papules.
  • Infantile Acrochordons (Skin Tags): While more common in adults, skin tags can occasionally be found in infants. They are small, usually flesh-colored, and hang from the skin.

Do Not Miss Diagnoses

  • Congenital Melanocytic Nevi: Although these are typically pigmented, some may be amelanotic (without pigment) and could present as flesh-colored papules. Early detection is crucial due to the potential for malignancy.
  • Leukemia Cutis: Cutaneous manifestations of leukemia can be varied and, in rare cases, might present as flesh-colored papules. This diagnosis is critical to consider due to its severe implications.

Rare Diagnoses

  • Trichoepithelioma: A rare, benign tumor of the hair follicle that can present as a small, flesh-colored papule. It's part of a spectrum of basal cell nevus syndrome in some cases.
  • Accessory Tragus: A small, usually flesh-colored, pedunculated lesion that represents an embryological remnant. It's typically found on the jawline or preauricular area.
  • Nevus Sebaceus of Jadassohn: A congenital skin lesion that can appear as a yellowish or flesh-colored plaque or papule, often on the scalp. It has the potential for malignant transformation later in life.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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