Baby skin conditions

Posted on 13 July 2016

Soft, smooth and blemish-free baby skin is much rarer than you’d think. Dr Yolandi Visser, a paediatrician at Mediclinic Panorama, discusses common baby skin conditions and the signs that may indicate an underlying problem.

From birthmarks that generally fade with time to eczema that may be irritating but not dangerous, baby skin problems are common. However, for new parents it might be hard to tell what’s normal and what requires medical attention.

Common baby skin conditions
According to Dr Visser, the seven most common (and generally harmless) baby skin conditions are:

1. Neonatal acne
Also known as baby pimples, this appears during the first couple of days after birth and is very common. It looks like ordinary pimples, the skin is usually red, and it can form all over the body.

It’s not harmful and is caused by maternal hormones transferred in-utero to the baby. Sometimes it can persist for a couple of days or even weeks, especially if the mother is breastfeeding and hormones are still transferred via breast milk. Neonatal acne will go away by itself and isn’t painful or irritating for the baby.

2. Erythema toxicum
While not presenting as often as neonatal acne, this is commonly seen in newborns, and the underlying cause isn’t known. It usually appears on day two to five and looks like a bad case of baby pimples – papules or pustules surrounded by red blotches and a widespread red rash on the face and body.

Although babies might look ill they feel fine and continue feeding. The condition is self-limiting, which means it goes away on its own after a week or two.

3. Cradle cap
This is very common and is a form of eczema that babies get on their heads. The whole head can be covered in thick, scaly skin, and is caused by excessive sebum, the natural oil produced by the sebaceous glands. It can look very unpleasant and usually worries parents more than babies.

Cradle cap differs from the eczema babies get on their bodies, and one doesn’t indicate the presence of the other. It’s not genetic and can sometimes just present as a few dry patches on the scalp.

While it can be left to heal by itself, there are various creams on the market that make the scaling softer and less unsightly, although it doesn’t eliminate the condition. Cradle cap can take up to a year to resolve, although it generally gets better within the first two to three months.

4. Milia
Some babies get little white bumps or spots on their noses, which can also spread to the cheeks or the chin. Milia are caused by dead skin trapped underneath the outer layer of skin and usually appear in the first two days after birth. This condition is also self-limiting, and when the old skin dies off it just disappears.

5. Eczema
Commonly seen, eczema has a different distribution in older children and adults than in babies. With babies it starts on the cheeks, appearing as dry red scaling on the skin. It can sometimes also be seen on the neck, the feet or the creases of the elbows and knees.

It is caused when skin cells don’t fuse well because of an underlying pathological cause and is familial, so if the baby’s grandparents or parents had baby eczema, look out for the signs. Eczema can be itchy, which will irritate the baby. Use emollients as a preventative measure from the beginning when bathing and moisturising your baby. If the eczema gets worse and doesn’t improve with emollients and plain baby soaps, there may be an underlying allergy, most often cow’s milk or gluten.

If treatment isn’t working, try eliminating these foods from baby’s diet or your own if you’re breast-feeding. Your GP or paediatrician might prescribe antihistamine to relieve symptoms if the baby is really miserable and itchy or scratching. In extreme cases, if the eczema gets infected and pustules and fever develop, antibiotics may be prescribed.

6. Nappy rashes
It’s important to know the difference between normal and fungal nappy rash. Normal nappy rash is a contact dermatitis, so the rash will only appear where the skin has been in contact with a fabric and won’t show in the baby’s skin folds. A fungal rash is characterised by redness or pustules in the skin folds around the groin. Fungal nappy rash usually has satellite lesions, which start out as one lesion and then spread all over with little groups of skin redness.

There are different treatments for the two types of nappy rash. For normal rash, change nappies frequently and use nappy creams that contain zinc. If you’re really struggling to contain it, probiotics can be added to the ointment. Fungal nappy rash is treatable with antifungal products, and you should consult your doctor or paediatrician.

7. Mongolian spots
These appear on the baby’s back or bum as massive blue spots that look like bruises. Affected babies are usually born with these spots. They’re completely harmless and disappear with time.

Warning signs
Dr Visser says you should seek medical help for skin conditions when the baby is:
– ill
– has a fever
– is irritable
– is not feeding
– develops a new rash that you’re unfamiliar with
– develops a mole that changes or gets significantly larger.

‘If you see bleeding underneath the skin in small spots or patches that aren’t blanching (lightening) and the child is acutely ill, consult your doctor as soon as possible as this may indicate a pneumococcal infection, which is rare in small babies but needs to be ruled out,’ Dr Visser cautions.