Rashes are extremely common in babies. During the first four weeks of their life they suffer various dermatologic skin problems. A lot of these conditions last only a short time and will go away. Most of them are transient. However, serious infectious, congenital skin diseases and sometimes malign tumors should be taken into consideration. Neonatal skin conditions are common. Infants with unusual presentations or signs of systemic illness should be evaluated for Candida, viral, and bacterial infections. Milia and miliaria result from immaturity of skin structures. Almost all of these skin rashes are a serious concern for parents and in such situation they should visit to the physician.
A study concluded that more than 95% of newborns have cutaneous findings, which often are distressing to parents. Clinicians need to recognize these skin conditions and differentiate them from more serious conditions, such as infectious pustular eruptions from bacterial, viral, and fungal causes, and inflammatory conditions, such as Langerhans cell histiocytosis. Notable bacterial pustular eruptions are bullous impetigo and congenital syphilis. Viral pustular dermatoses include neonatal herpes simplex virus infection and varicella zoster virus infection, which consists of congenital varicella syndrome, perinatal varicella, and infantile zoster. Fungal pustular eruptions include congenital and neonatal candidiasis. Diaper dermatitis encompasses a broad clinical diagnosis, including allergic and irritant contact dermatitis, atopic dermatitis, infections, psoriasis, and other dermatologic conditions. Critical components of baby skin care are immersion bathing, umbilical cord care, and use of emollients to augment skin barrier function.
Recognition of these dermatoses allows the physician to proceed appropriately, reassure the parents and initiate the further evaluation or treatment. To avoid adverse, special attention must be given to more persistent conditions and those with the potential for complications or malignant transformation. Consultation with a pediatric dermatologist, a plastic surgeon or a neurosurgeon may be necessary.
Skin rashes can look different on different babies’ skin. As a parent, you may not know if the skin rash is something to worry about. The causes of these conditions are variable and can include etiologies ranging from infectious to inflammatory to congenital.
Common neonatal skin conditions
- Infantile Hemangiomas – They are benign vascular neoplasms composed of proliferating, plump endothelial cell. They are common tumors of infancy. They are found mainly in females. The significant risk factor is low birth weight, premature birth, multiple gestation pregnancies, advanced maternal age, preeclampsia, placental abnormalities etc.
They can be classified into categories like superficial hemangiomas (found in uppermost layer of the skin); deep hemangiomas (occur in the dermis and subcutaneous tissue); and mixed hemangiomas (contain superficial and deep components).
Although the commonly occur in the skin but can also develop at extra-cutaneous areas like mucous membranes and internal organs. Their appearance can differ depending on the depth of the lesion.
- Desquamation - Desquamation, or skin peeling, is something that affects most babies in the first few days of life, especially if they are born after their due date. It is completely normal. To treat them, apply moisturizer to the skin.
- Cradle cap - This is a crusty greasy scalp rash that commonly occurs in the babies. It happens when there is a build-up of sebum that makes skin cells stick together instead of shedding normally. It can occur on the scalp alone or with a diaper, neck, or underarm rash. To treat them, apply mineral oil or petroleum jelly to loosen the crusts. Cradle cap usually clears up within a few weeks to months.
- Miliaria - Commonly call "prickly heat" or "heat rash", it has many different appearances like you could find tiny red bumps or little blisters filled with fluid or pus, usually on the baby's chest or back, underarms, or neck. It happens when sweat ducts on the skin become blocked. It sometimes appears after intense heat or if the baby is too bundled up. The rash eventually disappears on its own without any treatment.
- Newborn acne - This is a very common rash for babies. It occurs mostly on the nose and forehead and looks like pimples or blackheads. Newborn acne is thought to happen when either the mother's or the baby's hormones cause the baby's glands to produce more sebum. Sometimes this acne is also caused by yeast that lives on the skin. The rash usually goes away on its own in the first few months, but treatment may be needed in some cases.
- Milia - These are small white bumps on the baby's face. They look like whiteheads, but they are small cysts filled with sebum and keratin. Sometimes milia are present in the gums. They are very common during the first few days of life and go away eventually without any treatment.
- Nevus Sebaceous – It is circumscribed hamartoma composed of sebaceous glands. It is usually noted as a solitary, hairless patch on the scalp or as a velvety, tan or orange plaque in the other areas. It is characterized by association of a nevus sebaceous with multiple anomalies including intracranial masses, seizures, mental retardation, skeletal abnormalities, ocular lesions and hamartomas of the kidney.
- Transient pustular melanosis - Transient pustular melanosis is a type of rash that is more common in darker-skinned babies. It appears from birth as tiny white raised bumps on a baby's neck, chest, back, or buttocks. The bumps will go away on their own, but sometimes they leave slightly darker marks on the skin.
- Erythema Toxicum Neonatorum – It is a benign self-limited asymptomatic skin condition that affects 70 percent of babies. It typically presents within the first four days of life. The diagnosis can be made with history and physical examination alone, though a Wright stain of pustular contents demonstrates eosinophils.
- Nevus simplex - Nevus simplex is a pink or reddish patch of skin between the eyes, on the forehead, or on the back of the neck. People commonly call these patches "stork bite" or "angel's kiss." They are caused by dilated blood vessels that give the skin a reddish colour. Most of these patches disappear within two years.
- Vascular malformations - Vascular malformations are another common skin condition caused by blood vessels. They can look very different depending on the type of blood vessels involved and where they occur on the body.
The most common malformations are called "port wine stains" because they look like dark red areas of skin. When these malformations are large and are near the eyes, the doctor should check the baby to make sure the blood vessels in their brain and inside the eye are healthy. These condition stay with a child for the rest of their life.
- Mongolian spots - These are grey or bluish areas of skin that sometimes look like bruises. They are very common in Asian children and usually occur on the back or the buttocks. They usually fade within the first two years.
- Melanocytic nevi - Melanocytic nevi are more commonly known as moles. They are made of the cells that produce the pigment, or colour, of the skin and are light or dark brown. A lot of babies have tiny moles since birth or in the first few months of life. However, some babies have large or many moles all over their body and will need to be examined by a doctor. Moles do not disappear with time.
- Suction blister - Suction pressure can produce a blister on any part of the body that an infant's mouth can reach. The blister is a clear bullous lesion with no surrounding erythema. The lesion can be present at birth as bulla, an erosion or a crusted lesion. If the affected arm or leg is moved to the infant's mouth, the infant will usually begin sucking.
Cultures of the lesion are negative for bacteria, fungi and viruses. If the blister ruptures, a topical antibiotic ointment must be applied to prevent secondary bacterial infection.
- Aplasia cutis congenital - This is present at birth and may be ulcerated, bullous or atrophic in appearance. The most common location is the scalp, near the vertex, although these lesions may occur anywhere on the body.
Histopathologic examination reveals an absence of epidermis and dermal appendages. In the newborn period, it is important to avoid trauma and secondary infection. Smaller lesions typically heal as an atrophic scar and are easily covered by scalp hair. Larger lesions may require surgical intervention. The lesions of aplasia cutis congenita clinically are somewhat heterogenous.
- Eczema - Eczema can begin in the first few weeks of life, or may not begin until your baby is older. Eczema is dry skin that gets red and irritated, mostly seen on the scalp, face, trunk, elbows, knees or the diaper area. Apply Vaseline or an unscented moisturizing lotion to keep skin from becoming too dry. If the skin continues to look red and irritated, contact your baby’s doctor.
- Harlequin colour change - Harlequin color change occurs when the newborn lies on his or her side. It consists of erythema of the dependent side of the body with simultaneous blanching of the contralateral side. The color change develops suddenly and persists for 30 seconds to 20 minutes. It resolves with increased muscle activity or crying. This phenomenon affects up to 10 percent of full-term infants, but it often goes unnoticed because the infant is bundled. It occurs most commonly during the second to fifth day of birth and may continue for up to three weeks. Harlequin color change is thought to be caused by immaturity of the hypothalamic center that controls the dilation of peripheral blood vessels.