Differential Diagnosis for Dry and Erythematous Periorbital Rash in Newborns
- Single Most Likely Diagnosis
- Erythema toxicum neonatorum: This is a common, benign condition that appears as a rash on the skin of newborns, often within the first few days of life. It can present with erythematous patches, including around the eyes, and is self-limiting.
- Other Likely Diagnoses
- Atopic dermatitis (eczema): Although it typically starts later in infancy, atopic dermatitis can sometimes present early with dry, erythematous skin, including around the eyes.
- Irritant contact dermatitis: Newborn skin can be sensitive, and exposure to irritants (e.g., soaps, lotions) can cause a dry, erythematous rash, particularly in areas like the periorbital region where skin is thinner.
- Seborrhoeic dermatitis: This condition can cause a rash that is erythematous and sometimes dry, particularly in areas rich with sebaceous glands, including the face and around the eyes.
- Do Not Miss Diagnoses
- Herpes simplex virus (HSV) infection: Although less common, HSV can cause a severe, potentially blinding infection if it involves the eyes. Any sign of ocular involvement (e.g., vesicles, discharge) warrants immediate investigation for HSV.
- Congenital syphilis: This condition can cause a variety of skin rashes, including around the eyes, and is critical to diagnose due to its potential for serious complications if left untreated.
- Rare Diagnoses
- Staphylococcal scalded skin syndrome (SSSS): Caused by staphylococcal toxins, SSSS can lead to widespread skin erythema and exfoliation, including the periorbital area, though it typically presents with more systemic signs and is less common in the first few days of life.
- Congenital rubella: Now rare in areas with widespread vaccination, congenital rubella can cause a variety of symptoms, including a rash that might appear around the eyes, along with other systemic findings.