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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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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.

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