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Skin Rashes in Children (cont.)

Rashes in the Newborn

When you bring your baby home from the hospital, every little bump or red patch causes alarm. It is normal for your baby to have some skin rashes. After all, he or she has suddenly been forced to adapt to an environment that is not what he or she was used to (amniotic fluid). Diaper rash, cradle cap, and a host of other conditions are common in newborns. If you suspect that your child has more than a simple skin irritation, it is best to see a doctor.

Milia

  • Symptoms
    • Small (1 mm) white bumps which may appear of the nose, cheeks, and chin of approximately one-half of all newborns.
  • Treatment
    • Milia resolve spontaneously over the first few weeks of life. No therapy is necessary, and the bumps do not cause scars.
    • Milia are not contagious.

Seborrheic Dermatitis (Cradle Cap)

  • Symptoms
    • Cradle cap is a greasy, scaly, red, bumpy rash that can occur on the scalp, behind the ears, in the armpits, and the diaper area. It commonly presents at about 6 weeks of age and can resolve spontaneously within a few months. It is not contagious and will not scar. It is not itchy and is generally believed not to bother an infant. While several theories have been proposed, the exact cause has not been completely identified. It is not due to poor hygiene.
  • Treatment
    • Therapy commonly involves daily shampooing of the scalp and other involved body areas. Gentle rubbing to remove the greasy scales using a facecloth, hairbrush, or your fingernails is usually helpful. If the area is more heavily involved, applying baby oil to the affected area may be helpful. Occasionally your pediatrician may recommend the use of a medicated shampoo (for example, Head and Shoulders, Sebulex, T-Gell). Once the rash is resolved, washing the scalp or other regions every few days will help to keep the area rash free.

Infantile Acne

"Baby acne" commonly develops at about 2 weeks of age, increases in intensity for two weeks, and resolves without scarring over the next two weeks (total duration of condition is thus six weeks). While the exact cause of infantile acne is unknown, most doctors believe it represents a sensitivity of the baby's oil glands to the maternal hormone level of pregnancy. The rash most commonly involves the cheeks and nose.

Erythema Toxicum

This rash has a scary name but should really be called "the normal newborn rash" because it occurs in about half of all newborns.

  • Symptoms
    • The rash is characterized by multiple flat red areas approximately 1 cm in diameter. Often in the center will be a small raised 2-3 mm white or yellow bump.
    • The rash starts with small blisters on a red base.
    • Sometimes only the blotchy red base shows, and sometimes the blisters have a white or yellow material inside.
    • The rash starts the second or third day of life and usually resolves without treatment in one to two weeks.
  • Treatment
    • Since the rash is not serious and is not contagious, it does not require treatment.
    • The rash can look somewhat similar to other types of rash, so see your doctor with any questions or concerns.

Miliaria (Prickly Heat)

This rash includes small, clear blisters usually on the nose. It is caused by the production of sweat in a warm environment and plugged sweat glands. This rash is more common when the child is dressed too warmly. It gets better on its own.

Candidal Rash (Yeast Infection)

This diaper rash is a fungal or yeast infection of the skin by Candida albicans. This is the same organism that causes thrush, the white plaques in the mouths of infants. The combination of the moist diaper environment and the presence of C. albicans in the normal gastrointestinal tract of children facilitates the development of a Candida diaper rash.

  • Symptoms
    • An intensely red, raised rash with discrete borders is found. The borders may have a ring of fine scales. The rash may involve the genitalia of boys and girls. In addition, occasionally Candida infection may occur around the anus.
    • Surrounding the main area of rash there may be smaller lesions, called satellite lesions, which are characteristic of Candidal diaper rashes.
    • The rash tends to involve the skin creases and folds because of the warm, moist environment. This characteristic may help in distinguishing Candida rash from irritant diaper rash that commonly will spare these areas (see below).
  • Treatment
    • This rash is easily treated by medications available from your doctor, but it tends to recur.

Seborrheic Dermatitis

A greasy, scaly, red diaper rash, seborrheic dermatitis tends to occur in the creases and folds just as in Candida rashes. Unlike Candida rashes, the rash is usually not intensely red or scaly but instead is usually moist and greasy in appearance. This rash is not harmful and can be easily treated by your doctor.

Irritant Diaper Rash

The effects of urine and feces on the sensitive skin of the newborn cause this rash. The creases and folds are spared in this rash, unlike seborrhea or Candida diaper rash.

  • Treatment
    • To prevent diaper rash, change soiled or wet diapers as soon as possible.
    • Make sure that baby clothing is well rinsed, and do not use fabric softeners because this may irritate delicate skin.
    • Many doctors suggest allowing the bottom to go bare for several hours a day, especially to help heal a diaper rash.
    • Topical ointments with zinc oxide also provide a barrier and may help with healing of a diaper rash.
    • Extra bathing will also promote resolution of this common rash.

Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics

Author: John Mersh, MD, FAAP
Editor: Melissa Conrad Stöppler, MD, Chief Medical Editor, eMedicineHealth.com

Previous contributing author and editors:

Author: William A Gibson, MD, Faculty, Department of Emergency Medicine, Brooke Army Medical Center, San Antonio Texas.

Editors: Scott H Plantz, MD, FAAEM, Research Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Thomas Rebbecchi, MD, FAAEM, Program Director, Assistant Professor, Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey.

REFERENCES:

Baker RC, Seguin JH, Leslie N, et al. Fever and petechiae in children. Pediatrics. Dec 1989;84(6):1051-5. [Medline].

Behrman RE, Jenson HB, Kliegman R, eds. Nelson Textbook of Pediatrics. 18th ed. WB Saunders Co; 2007.

Buckingham SC, Marshall GS, Schultze GE, et al . Clinical and laboratory features, hospital course, and outcome of Rocky Mountain spotted fever in children. J Pediatr 2007; 150(2): 180-4, 184.e1

Dantas-Torres F. Rocky Mountain spotted fever. Lancet Infect Dis 2007; 7(11): 724-32.

Hans D, Kelly E, Wilhelmson K, et al. Rapidly Fatal Infections. Emerg Med Clin North Am 2008; 26(2); 259-279.

Harwood-Nuss AL, Wolfson AB, Linden CH, et al. The Clinical Practice of Emergency Medicine. 3rd ed. Lippincott Williams & Wilkins; 2005.

Hengge UR, Currie BJ, Jegger G, et al. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis 2006; 6(12): 769-79.

Hoppa E. Lyme disease update. Curr Opin Pediatr 2007; 19(3): 275-80.

Knuf M, Habermehl P, Zepp F et al. Immunogenicity and safety of two doses of tetravalent measles-mumps-rubella-varicella vaccine in healthy children. Pediatr Infect Dis J 2006; 25(1): 12-18.

Mandl KD, Stack AM, Fleisher GR. Incidence of bacteremia in infants and children with fever and petechiae. J Pediatr. Sep 1997;131(3):398-404. [Medline].

Newburger, JW, Takahashi, M, Gerber, MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004; 110:2747.

Thanassi WT, Schoen RT. The Lyme disease vaccine: conception, development, and implementation. Ann Intern Med. Apr 18 2000;132(8):661-8. [Medline].

Tintinalli JE, Kelen GD, Stapczynski JS, et al. Emergency Medicine: A Comprehensive Study Guide. 5th ed. McGraw-Hill; 2000.

Weston WL, Lane AT, Morelli JG. Color Textbook of Pediatric Dermatology. Mosby-Year Book, 4th ed., 2007.


Last Editorial Review: 4/8/2014

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Read What Your Physician is Reading on Medscape

Diaper Dermatitis »

A prototypical example of irritant contact dermatitis, diaper dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations.

Read More on Medscape Reference »


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