Newborn with unilateral colour change

The image depicts macular erythema with a distinct midline demarcation separating it from pale skin on the back of a newborn boy. This skin change occurred spontaneously and resolved on its own within a few minutes.

The infant was delivered at term and routine examinations in the maternity ward showed normal findings. Unilateral erythema on the infant's face was observed during breastfeeding. During a paediatric examination, the infant appeared healthy, showing no signs of discolouration or other pathology. When placed in a supine position during the examination, the unilateral erythema reappeared with the same characteristics as before and spontaneous resolution after a few minutes. Based on the medical history, the absence of clinical signs of disease, and the features of the skin discolouration, the condition was deemed consistent with Harlequin colour change.

Harlequin colour change is a benign condition seen in up to 10 % of term newborns but is often not observed because the infant is fully clothed (1, 2). The condition involves transient unilateral erythema and/or simultaneous pallor on the opposite side, with a clear midline demarcation (1, 2). It typically occurs within 2–5 days after birth but has been observed up to three weeks postpartum (1). The duration ranges from a few seconds to 20 minutes.

The aetiology of Harlequin colour change remains unclear, but autonomic dysregulation of the cutaneous blood vessels is the leading hypothesis (2). Less commonly, it may be associated with underlying pathology such as birth injuries or structural or iatrogenic lesions (1, 2). In the absence of signs or symptoms of underlying pathology, no investigation or treatment is required.

Observing unilateral skin discolouration can be alarming for parents, so providing reassurance about the benign and self-limiting nature of the condition is crucial.