Newborn babies can develop various types of skin rashes, caused by many different factors. Most are harmless and resolve spontaneously but others can be dangerous and may even be life-threatening for the baby.
Causes of Skin Rash in Newborn Babies
A rash is a reaction of the skin due to any cause, such as :
- Infection – bacterial, fungal or viral.
Most rashes caused by viruses are not serious and do not harm the baby. They usually do not require any treatment and disappear on their own. Viral infections such as chicken pox, rubella, or measles may become serious in newborns because of their weak immune system.
- Allergic reaction.
- Skin irritation.
- Drug reaction.
- Normal physiologic skin changes.
Skin rashes in newborns may be due to a number of causes, the most common ones being :
Diaper Rash (Diaper Dermatitis)
- Bright red rash caused by irritation of the baby’s skin beneath the diaper (buttock, thigh, groin and sometimes lower back) by prolonged contact with urine or stool.
- Neglecting to change or remove wet and soiled diapers over a long period of time can cause this type of rash.
- Diaper rash can also be caused by a fungal infection (candidiasis), which is usually seen in the creases of the skin.
- Rarely, bacteria may be responsible for causing a diaper rash.
- Frequent change of diapers, washing the skin gently, application of moisturizer, and use of an antifungal or antibacterial cream can help to treat this condition.
Cradle Cap (Seborrheic Dermatitis)
- Red and yellow scaling, crusty rash usually seen on the baby’s scalp. It may sometimes occur in the skin folds.
- It is a harmless condition and the cause is not known.
- Usually disappears by 6 months of age.
- Regular shampooing, massaging mineral oil into the scalp, use of selenium shampoo and corticosteroid creams may be helpful.
Eczema (Atopic Dermatitis)
- Red, scaly, dry rash occurring most frequently around the limb joints (brachial fossa/elbow, popliteal fossa/behind knee). It may also be seen behind the ears or at other skin creases.
- Patchy skin rashes are intermittent, appearing more frequently in cold, dry weather.
- Eczema usually runs in families.
- Often associated with asthma.
- The cause is unknown but allergy (immune-mediated hypersensitivity) could be a factor.
- Use of skin moisturizers, corticosteroid creams and anti-allergic drugs may give some relief.
- Harsh soaps, detergents or even saliva from drooling can cause irritation of the skin.
- Skin may be red and itchy.
- With allergic contact dermatitis, there may be crusting and oozing, in addition to a red and itchy skin.
- Moisturizers and mild hydrocortisone creams may help.
- Allergic reaction to drugs may appear as hives or urticaria, with red, itchy, raised areas of skin.
- Drugs such as penicillin may cause a drug reaction.
- This is a very common type of rash seen in newborn babies.
- It looks like mosquito bites or urticaria.
- The cause is unknown but it usually starts on the second or third day of life.
- Does not require any treatment.
- Resolves on its own in a few days or weeks.
- Starts as a small red bump on the skin and rapidly becomes a honey-colored crusted plaque.
- Usually seen around the nose but may occur anywhere on the body.
- Caused by a bacterial infection.
- Treated by an antibiotic cream.
- May need oral antibiotics if severe.
- Small pimple-like pustules on the baby’s skin.
- It is a bacterial infection caused by Staphylococcus aureus (Staph infection).
- Usually seen in the creases of the baby’s neck and under the arms.
- Antibiotics may sometimes be necessary for treatment.
Miliaria (Heat Rash or Prickly Heat)
- Common on the head, neck, upper chest, and skin folds.
- Small fluid-filled vesicles, sometimes with red irritated skin.
- Caused by extremely hot and humid climate.
- Usually resolves on its own.
Neonatal Acne (Acne Neonatorum)
- Small pimples or red bumps on the face.
- Typically seen on the forehead, nose and cheeks.
- Usually appears between 2 to 4 weeks of age but may be present at birth.
- May occur due to stimulation of the sebaceous glands by maternal hormones.
- Treatment is usually not necessary.
- Rash heals on its own within 4 months without any scarring.
- This is a fungal infection of the skin and is commonly referred to as a ringworm.
- Tinea capitis is infection of the scalp and may not always present with he typical round-shaped rash.
- Tinea corporis or ringworm infection of the body usually presents as a ring-shaped skin patches are seen.
- The rashes are accompanied by scaling and itching.
- They tend to spread in the moist areas of the skin.
- Treated by local application of antifungal drugs.
- It presents as a cluster of flesh-colored or white smooth bumps on the skin.
- It is caused by a viral skin infection.
- The virus is highly contagious.
- It can spread by direct skin contact.
- It usually disappears without any treatment.
- A mild viral infection.
- Fever, usually subsiding after 4 days, is followed by a rash.
- It is a self-limiting disease.
Erythema Infectiosum (Fifth Disease)
- This is also a mild viral infection and a mild fever may be present.
- A red rash on the face, looking like a slapped cheek.
- No treatment is necessary.
- This is a potentially life-threatening bacterial infection, usually caused by Neisseria meningitides.
- It is a highly contagious disease.
- Fever with petechial rash is seen.
- Petechiae are red dots on the skin (caused by broken capillaries), which do not disappear on applying pressure, and appear like bruising of the skin.
- The rash may start as small bumps and then develop into petechiae.
- Nausea and vomiting may be noted. Headaches and muscle pain may be difficult to detect in a newborn.
- Immediate medical attention is necessary.
- These are pearly cysts on the face of newborn babies, usually over the nose and cheeks.
- Caused by the first secretions of the baby’s oil glands.
- It is not contagious.
- No treatment is necessary.
- They disappear on their own soon after birth, usually within a few weeks.
Certain skin markings and birth marks may be found in a newborn baby, such as :
- These are caused by injury to skin and soft tissue of the baby (usually around the face and scalp) during normal delivery or due to use of forceps.
- Injury marks on scrotum or labia may be seen after breech delivery.
- No treatment is necessary in most cases.
- These are birthmarks on the forehead between the eyes (angel’s kiss), upper eyelid, or back of neck (stork bites).
- They usually fade as the baby grows but may remain as light-colored marks which become more prominent when the person gets agitated.
White Cysts (Epstein’s Pearls)
- May be seen on the gums or on the roof of the mouth as whitish-yellow cysts.
- Very common in newborns.
- Usually disappear within 1 to 2 weeks of birth.
- No treatment required.
- Bluish-grey flat areas on lower back or buttocks.
- Usually seen in black or Asian newborn babies.
- Tends to fade or disappear as the baby grows.
Strawberry Hemangioma (Birthmark)
- Initially seen as a flat, red or purplish area but becomes more raised and darker red in color over a few weeks.
- After a few years it may shrink in size and become lighter in color or fade away.
- It may occur anywhere on the body.
- Usually no treatment is necessary.
- Yellowish discoloration of the skin and sclera (whites of the eyes).
- Caused by excess bilirubin in the blood as a result of breakdown of red blood cells.
- Physiological jaundice, which appears 2 or 3 days after birth and usually clears by about 2 weeks, is of no concern.
- Jaundice can be a sign of a serious underlying problem, especially if it appears within 24 hours after birth.
- Usually no treatment is necessary.
- Phototherapy may be done if the bilirubin level (blood test) is very high.
- Exchange transfusion may be necessary in severe cases.