Milia. A milium is a white papule, 1–2 mm in size, composed of laminated, keratinous material and situated as a solid cyst in a pilosebaceous follicle. Milia are fairly common on the brow, glabella, and nose in newborn infants and in such infants tend to disappear quickly and spontaneously. There may be few or many, and they may develop later in infancy, in childhood, and in adolescence. In older children and adolescents, they tend to macules may be sparse or numerous and resolve without residua over a period of several weeks to several months.
Peutz-Jeghers syndrome. Scattered dark brown macules on the lips and buccal mucosa of a child with Peutz-Jeghers syndrome. The pigmented macules on the lips may fade with time, but the intraoral pigmentation persists for life.
Nickel contact dermatitis. Allergy to nickel is one of the most common causes of contact dermatitis in children. Infants may present with skin lesions corresponding to the location of snaps on their pajamas or other garments. Older children may show reactions to watches, chains, belt buckles, or earrings.
Nickel contact dermatitis. The development of an itchy eczematous eruption near the umbilicus is virtually pathognomonic for contact dermatitis to nickel. The source is the small metal snap in the blue jeans or the metal belt buckle. The simultaneous occurrence of an id reaction, sometimes with small lichenoid papules on the elbows and knees, is very common. Lesions can be treated effectively with topical corticosteroids, but the only cure results from strict avoidance of nickel. This is easier said than done. Parents must buy jeans without snaps or sew in a small piece of fabric to protect the underlying skin. Families should be reminded that wearing jeans with a metal snap for just several hours out of the month would reactivate the entire process. Children with contact dermatitis to nickel should also avoid metal jewelry and should be advised against ear piercing.