Newborn Rashes and Skin Conditions

Topic Overview

What are the most common skin conditions in newborns?

It’s very common for newborns to have rashes or other skin problems. Some of them have long names that are hard to say and sound scary. But most will go away on their own in a few days or weeks.

Here are some of the things you may notice about your baby's skin.

• It looks like pimples.
  • Babies often get pimples on their cheeks, noses, and foreheads. This baby acne may show up during the first few weeks of life and usually clears up on its own within a few months. Baby acne has nothing to do with whether your child will have acne problems as a teenager.
  • Tiny white spots very often appear on a newborn’s face and gums during the first week. The spots are called milia (say "MIL-ee-uh"). Sometimes they also appear on the roof of the mouth (palate), where they are called Epstein pearls. Milia go away by themselves in a few weeks and aren't harmful.

• The baby's skin looks blotchy.
  • During the first day or two of life, many babies get harmless red blotches with tiny bumps that sometimes contain pus. This is called erythema toxicum (say "air-uh-THEE-mah TOK-sik-um"). It may appear on only part of the body or on most of the body. The blotchy areas may come and go, but they will usually go away on their own within a week.
  • A rash called pustular melanosis (say "PUS-chuh-ler mel-uh-NOH-sis") is common among black infants. The rash is harmless and doesn't need treatment. It causes pus-filled pimples that may break open and form dark spots surrounded by loose skin. Babies are born with it, and it usually goes away after the first few days of life. Sometimes dark spots may last for a few weeks or months.
  • When cold, your newborn may get a blotchy, lace-like rash (mottling) on the limbs and torso. Remove your baby from the cold source, and the rash will usually go away. Mottling usually doesn't occur past 6 months of age.

• The baby has a rash.
  • Babies can get heat rash , sometimes called prickly heat, when they are dressed too warmly or when the weather is very hot. This is a red or pink rash usually found on the body areas covered by clothing. It often itches and makes your baby uncomfortable. Doctors call this rash miliaria (say "mil-ee-AIR-ee-uh"). To help the rash go away, remove your baby from the warm setting. Dress your child in light, loose clothing and give him or her a cool bath. For more information, see the topic Heat Rash.
  • Diaper rash is red and sore skin on a baby's bottom or genitals that is caused by wearing a wet diaper for a long time. Urine and stool can irritate the skin. Diaper rash can happen when babies sleep for many hours without waking. If your baby has diaper rash, take extra care to keep him or her as dry as possible. Sometimes an infection from bacteria or yeast can cause a diaper rash. If the rash doesn't clear up in 2 or 3 days, see your doctor. For more information, see the topic Diaper Rash.
  • Many babies have a rash off and on around the mouth or on the chin. It's caused by drooling and spitting up. Clean your baby's face often, especially after he or she eats or spits up. For more information, see the topic Spitting Up.

• The baby sometimes has tiny red dots on the skin.
  • You may notice tiny red dots on your newborn’s skin or in the white of the eyes when he or she bears down to cry or have a bowel movement. These red dots are called petechiae (say "puh-TEE-kee-eye"). These are specks of blood that have leaked into the skin. They are caused by the trauma of being squeezed through the birth canal. They will disappear within the first week or two.

• The baby's scalp is scaly.
  • Many babies get what is called cradle cap . This scaly or crusty skin on the top of the baby's head is a normal buildup of sticky skin oils, scales, and dead skin cells. Unlike some other rashes, cradle cap can be treated at home with shampoo or mineral oil. Cradle cap usually goes away by age 1 year. For more information, see the topic Cradle Cap.

What are the common birthmarks?

Birthmarks come in different sizes, shapes, and colors. Some are flat and some form a raised area on the skin. Most are harmless and need no treatment. They often fade or disappear as a child grows older.

• Salmon patches,also called stork bites or angel kisses, are flat, pink patches that occur mainly on the back of the neck, the upper eyelids, the upper lip, or between the eyebrows. Most go away by age 2 years, although patches on the back of the neck usually last into adulthood.
• Moles are brown bumps that can occur anywhere on the body.
• Café-au-lait spotsare flat, brown birthmarks that are usually oval in shape. They may get bigger and darker, and your baby may get more of them throughout childhood.
• Mongolian spotsare smooth, flat, blue or blue-gray birthmarks, usually on the lower back and buttocks. They often look like bruises. They are very common among darker-skinned newborns, such as black, Asian, and East Indian babies. They usually fade by school age, but they may never disappear entirely.
• Port-wine stainsare pink-red at birth and then become a darker red-purple color. Port-wine stains are birthmarks formed by blood vessels that did not develop properly. They can be large. Light port-wine stains may fade, but about half get bigger as the child grows. Sometimes they get thicker and darker.
• Hemangiomas (say "hee-man-jee-OH-muhs") are raised, blue, red, or purple birthmarks formed by a clump of blood vessels that can be any size or shape. Most of them grow for about a year, then turn white and start shrinking.

Hemangiomas are the birthmarks most often treated. But many hemangiomas are not treated for the first couple of years of life, because most go away without any treatment or problems. For more information, see the topic Birthmarks.

What about jaundice?

Many newborn babies have a yellow tint to their skin and the whites of their eyes. This is called jaundice. In newborns, jaundice usually goes away on its own within a week and does not need treatment. But if you are nursing, it may be normal for your baby to have very mild jaundice throughout breast-feeding. As long as your baby is getting enough milk and is fed often (about 8 to 12 times every 24 hours), jaundice usually is not a problem.

In rare cases, jaundice gets worse and can cause brain damage. That is why it is important to call your doctor if you notice signs that jaundice is getting worse. If you think that your baby's skin or eyes are getting more yellow, or if your baby is more tired or is not acting normally, call your doctor. For more information, see the topic Jaundice in Newborns.

When should you call a doctor?

Always call a doctor if you have any concerns, if your baby is not acting normally, or if the skin shows signs of being infected. The signs can include:

• Increased pain, swelling, or warmth in the area.
• Red streaks extending from the area.
• Pus.
• Swollen lymph nodes in the neck, armpit, or groin.
• Fever of 100.4°F (38°C) or higher.
• An extra fussy baby.

When to call a doctor

Skin problem	Call your doctor if:
Diaper rash	The rash isn't better after 2 or 3 days. Your baby may have a yeast diaper rash.
Birthmarks	The birthmark bleeds or grows quickly.
Jaundice	Your baby’s yellow tint gets brighter or deeper, or it hasn't decreased by your baby's 5th day of life. Your baby seems very sleepy, is not eating well, or does not act normally. Your baby does not pass 1 or 2 stools or wet 2 diapers in 24 hours, or your baby shows signs of dehydration, such as strong-smelling urine with a dark yellow color. Your baby has a rectal temperature that is less than 97.8°F (36.6°C) or more than 100.4°F (38°C). Call if you cannot take your baby’s temperature but he or she seems hot. Your baby has any new symptoms or does not get better as expected.

If you have concerns about what lotions or other products to use on your baby's skin, talk to your baby's doctor at the next visit. Not all newborn skin conditions need to be treated with lotions and creams. You don’t usually need to use lotions and other products on healthy newborn skin.

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Author:	Debby Golonka, MPH	Last Updated: July 31, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Andrew Swan, MD, CCFP, FCFP - Family Medicine
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