Baby Blemishes

by Christine Haran

newborn with rashEveryone wants to have skin like a baby -- soft, clear, smooth and rosy. In reality, even infants can break out like teenagers. While the tiny blemishes and rashes can be upsetting to parents, they are usually harmless and require minimal treatment, if any.

It's often worthwhile to talk to your pediatrician about a given skin condition, however, as they can offer prevention and treatment guidance. Below, Daniel Krowchuk, MD, a professor of pediatrics and dermatology at Wake Forest University Health Sciences in Winston-Salem, North Carolina, reviews conditions that commonly affect infants, from cradle cap to diaper rash.

Are skin conditions common in newborns?
Yes, these may be divided into two categories. There are skin conditions that represent normal variations, meaning that lots of babies get them and they are of no consequence in the long term and usually resolve on their own. Then there may be other skin conditions that will persist and require evaluation and treatment.

What should routine skin care involve?
Parents should be aware that there is no one and only one way of caring for your baby's skin. Many of the skin care recommendations rely on common-sense regimen. There is some science behind recommendations, and then there's a lot of personal preference. For example, a baby -- a newborn, in particular -- may not need a bath every day, and therefore it's not necessary to give one. Obviously you're cleansing the diaper area, which gets dirty on a regular basis. There may be times, for example, during the winter in colder climates, when a baby's skin becomes dry and a moisturizer might be useful. It may be applied after bathing and at other times during the day, if needed.

Baby powders are often used, but they are not routinely needed. Some people apply them in areas where there's moisture, like in the diaper area or in the folds of the neck. The difficulty with powders is that they can be inhaled. Generally we recommend that parents stay away from them if they can. If you're going to use power, choose one that contains cornstarch rather than talcum power. Dispense a small amount on your hand, well away from the baby, and then just gently rub that on the area of skin you wish to treat.

In general, it's wise to choose products that are designed for infants, which often do not contain alcohol or fragrances that may be irritating to the infant's skin. I think most parents are pretty savvy; most know to use products that are designed for infants.

What is cradle cap?
Cradle cap is a form of seborrheic dermatitis and most commonly appears in babies as a scaling on the scalp. It can be mild or it can be fairly widespread. Seborrheic dermatitis is a self-limited condition, so by the time a baby gets to be eight or nine months of age, typically, it's quieting down.

If cradle cap is mild, a standard baby shampoo may be sufficient to help remove the scale. Some parents find that if they, when shampooing, use a soft brush designed for the scalps of babies, that will help lift off some of that scale. Some people prefer to apply a small amount of mineral oil to the scalp and then use the brush to loosen the scale. An antiseborrheic shampoo -- that's one of the dandruff shampoos -- could be used to help lift off the scale if other measures weren't effective. Generally, if you're at this point, it might be worth talking to your health care provider about selecting of one of these shampoos. Parents should use the shampoo on an as-needed basis. Once the scale is gone you can return to your infant's routine scalp care.

Do parents need to treat the flaky skin some infants are born with?
Flaking skin is a normal and temporary finding. No treatment is necessary. If the skin seems excessively dry or there's a little bit of cracking, which sometimes can happen in the skin folds -- for example, in the ankle -- then, a moisturizer may be helpful.

What is infant acne?
Neonatal acne is the acne that typically appears in the first few weeks of life. It is very common and it's caused in the same way that teenage acne is caused: by hormones. It's caused by male hormones called androgens, which are actually quite high in both male and female babies at around the time of delivery, and then tend to diminish over time. As those hormone levels decline, as they should, the acne tends to disappear. If the acne seems to be lasting longer or is particularly severe, meaning that somebody's seeing lots of red bumps or scars, then you'd want to talk to your provider.

What is erythema toxicum?
Erythema toxicum is a common skin rash and not a cause for any concern. It typically shows up in the first few days of life as little red blotches on the skin, and in the middle of the red blotch there can be a little bump. No one knows why this rash happens but it's absolutely harmless, it tends to go away in several days, and no treatment is needed.

What is prickly heat?
Heat rash often is called prickly heat but its technical name is miliaria. Nobody really understands exactly why babies have heat rashes, except that the sweat glands in the skin seem to become blocked up. You then get a little leak of the sweat outside of the duct, and that creates irritation or inflammation that results in a tiny red spot or bump about a millimeter or so in size.

Those spots tend to appear in areas where there are skin folds such as in the folds of the neck. They are more likely to happen if a baby becomes overheated. So heat rashes can occur in the summer months in warm climates, or if a baby is a bit too heavily dressed for the surrounding temperature. Sometimes heat rashes can be made worse if parents are applying thick moisturizers or other products.

Once a heat rash is established, if you have a fan or you have the option of air conditioning that may help both the condition disappear and prevent it from returning. It also helps to not overly dress infants. Remember that most infants are going to feel comfortable dressed in a way that you or I would feel comfortable.

What is diaper rash?
Diaper rash is very common, though much less so now that most people use disposable diapers. The things that cause diaper rash are moisture, typically from urine, coupled with rubbing of the diaper on the skin. When your skin is moist over long periods of time, its ability to withstand the forces of friction from the diaper is reduced. You add to that the effects of enzymes that are present in stool that act as irritating factors on the skin, and diaper rash may occur.

To prevent diaper rash, so make sure that you change the diaper when necessary, and if you need to, gently cleanse the area either with a hypoallergenic wipe or tap water on a soft wash cloth, and then pat the area dry and apply a new diaper.

If a diaper rash becomes established, usually it's going to be caused by irritation, so parents should apply some sort of a barrier preparation that's designed to keep moisture away from the skin. Everyone has their favorite preparation. Many people favor products that contain zinc oxide because they create a more or less impenetrable barrier for moisture. Other products such as A+D ointment and Desitin are also designed to create a barrier on the skin against moisture and help the skin heal.

Some pediatricians will prescribe a barrier preparation, but most are available over-the-counter.

Can babies get yeast infections on their skin?
If what parents thought was just an irritation diaper rash isn't going away after several days of treatment, it might be worth talking to your provider, because a yeast infection may have developed. The tip-off to a yeast infection is that usually it's fairly bright red in color, and it involves the areas of the skin creases as well as the thighs and the lower tummy, whereas a typical irritation rash usually doesn't involve the creases. In yeast infections, you might also see some bright red bumps that look like pimples a little bit beyond the main area of involvement.

Your provider can recommend anti-yeast over-the-counter products like clotrimazole or miconazole, or a prescription called nystatin. It depends a little bit on how severe the situation is when you first see the infant, but usually within several days to a week or so of beginning treatment things have improved.

When can a skin condition be a sign of allergy?
If a baby gets hives, it is usually an allergic response to something, such as to a medication. If an infant or a child gets hives it may be caused by an allergy to certain foods. Also, eczema is a very common skin condition is often associated with allergies, although in most children it's not caused by an allergy. Children who have very severe eczema that doesn't seem to respond well to treatment may have a food allergy that may trigger or worsen the condition.

When should parents consider seeing a doctor?
If parents notice the appearance of something on the skin in the setting of a perfectly well child, the next time they see their provider for a well visit, they ought to just bring it to the provider's attention. Most of the time what you see on the skin turns out to be absolutely harmless and does not need any additional evaluation or treatment. Occasionally things can merit treatment, particularly if there seem to be some symptoms associated with it. For example, children with eczema are often itchy and the skin is unsightly.

Christine Haran has been a health journalist for more than seven years, and her work has appeared in Woman's Day, MAMM Magazine, Bride's Magazine, Publishers Weekly and other publications. In 2003, she received an Excellence in Women's Health Research Journalism Award from the Society for Women's Health Research. Haran has a master's degree in journalism from New York University and a bachelor's degree in english from Skidmore College.

Copyright © Christine Haran. Permission to republish granted to Pregnancy.org, LLC.