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JAMA Dermatology Clinicopathological Challenge
April 2018

Trenchlike Ulcer on a Newborn’s Scalp

Author Affiliations
  • 1Medical student at Georgetown University School of Medicine, Washington, DC
  • 2Division of Dermatology, Department of Medicine, Georgetown University, Washington, DC
  • 3Department of Dermatology, MedStar Washington Hospital Center, Washington, DC
  • 4Division of Dermatology, Children’s National Medical Center, Washington, DC
JAMA Dermatol. 2018;154(4):473-474. doi:10.1001/jamadermatol.2017.4841

A neonate in her second week of life was brought to our hospital for evaluation of a scalp lesion initially thought to be an open abscess. She was born full term to a primigravid mother, who had an uncomplicated pregnancy. At parturition, the baby presented in occiput posterior position and remained partly crowned for more than 24 hours of maternal labor. Finally, due to failure to progress, the baby was delivered by urgent cesarean delivery. Birth weight was 3.13 kg (15th percentile), head circumference was 31 cm (<1 percentile), and Apgar score was 9 of 9. The baby’s head had a markedly elongate vertex, which the neonatal intensive care unit team diagnosed as cephalohematoma. On day 5 of life, her serum total bilirubin and conjugated bilirubin were 20.5 mg/dL (>95 percentile) and 0.3 mg/dL (to convert to micromoles per liter, multiply by 17.104), respectively. The girl was hospitalized for 1 day of phototherapy before being discharged home weighing 2.95 kg (−5.75%). She was exclusively breastfed.