A guide to infant rashes

Kirk Coverston, MD Kirk D. Coverston, MD, FAAP

Part 1 of 2

Newborn babies commonly experience rashes, and new parents commonly find themselves concerned.

As many as 95 percent of newborns will have a rash in their first year, and most are harmless. Still, it’s important for parents to be able to identify the rash, because some can be very serious.

Following are details on five of the 10 most common newborn rashes to help you know when to follow up with your primary care physician. 
Look for part two next month.


Erythema Toxicum
About 50 percent of newborns will develop this rash during the first 24 hours of life. It looks like little mosquito bites (firm, red, yellowish or white surrounded by a ring of redness). They can sometimes appear to be filled with fluid, which is not pus. It can be very mild, or dispersed over the entire body, but usually not on the hands or feet. It lasts 4 to 7 days and self resolves.

Neonatal Cephalic Pustulosis
This is a common rash, a variant of neonatal acne, which usually appears on the face and scalp of newborns in the third week of life. It differs from acne in that there are no black or white heads (comodones).  Studies show that this is related to a kind of fungus, and it usually resolves on its own, but a topical antifungal cream may be helpful.
Neonatal acne usually peaks around 2 months of age, associated with the infant’s sebaceous glands’ sensitivity to maternal hormones.  There may be associated comodones, and it can spread to other areas of the body in addition to the face.  This rash will generally heal on its own; however, if your baby has a severe case, see your primary care provider.   

Cradle Cap
Cradle cap, or seborrheic dermatitis, is quite common and is often confused with eczema. If localized to the scalp, the rash is scaly and crusty and usually begins in the first three months of life. It can be treated with baby oil and a fine-tooth comb, twice a day, along with a dandruff shampoo, as needed. Sometimes the rash can be yellowish, patchy and greasy and it can spread to the ears, eyebrows, eyelids and cheeks. If the rash is irritated, you can use an over-the-counter 1 percent Hydrocortisone cream twice a day for 7 days. 

Milia
This rash appears at birth as tiny, white bumps across the nose and cheeks. It is the result of keratin that has become trapped beneath the surface of the skin, and will go away on its own within the first few weeks.

Heat Rash (Miliaria Rubra)
This rash is found in the clothed areas of a baby, such as the back of the neck and the back. It occurs when the sweat glands are blocked and can’t evaporate. The area becomes red and there is an all-over itchy, or prickly feeling to the skin. This rash will go away when the skin cools.  The only concern would be with a secondary infection to the area.  Prevention, through loose and non-synthetic clothing, is the most important treatment.

 


(Dr. Coverston is a Board-certified pediatrician who practices at Visalia Medical Clinic. He is a Fellow of the American Academy of Pediatrics and has been in practice in Tulare County since 2012.)