As your new baby adapts to life outside the womb, he or she will experience many changes, including those in the largest organ – the skin. It is helpful to learn about the more common skin changes, birthmarks, and rashes you may see. Although most of these conditions are a normal part of your infant’s development, you may notice some that concern you. Especially during the first few weeks of your baby’s life, consult your child’s doctor if you have questions or concerns.
All babies are born with a whitish protective covering on their skin called vernix. Once
this vernix is washed off, Cradle capyour baby’s skin is exposed to air for the first time. As
the skin dries during the first few days of life, it is normal for a very thin layer to flake off. Infants who are born after 40 weeks’ gestation often have dry, cracked skin, especially on their hands and feet, which usually goes away within the first month. To help ease dryness, use gentle moisturizers and avoid frequent bathing.
You may also notice tiny (1–2 mm) whitish bumps on your newborn’s nose, cheeks, chin, or forehead. These harmless bumps, called milia, are present in about 40% of newborns and will resolve within a few weeks. They may also appear in the mouth, where they are referred to as Epstein’s pearls. Another benign condition, sebaceous gland hyperplasia, can look similar to milia, with tiny Strawberry Hemangioma yellowish bumps on the nose
and cheeks. These are caused by maternal hormones and will clear by 4–6 months.
There are a variety of birthmarks that you may see in your newborn. The most common are:
Nevus simplex (commonly called salmon patch, stork bite, or angel kisses)
These benign salmon-colored patches are usually seen on the back of the neck, between the eyes, or on the scalp, and most resolve within 18 months.
Dermal melanosis (commonly called mongolian spots or blue-gray spots)
Most common in newborns that have darker skin, this flat blue-black patch, usually on the lower back and buttocks, can be mistaken for a bruise. They usually fade with time and are benign.
Nevus flammeus (commonly called port-wine stain)
This dark red, flat patch can be seen on any part of the body. Unfortunately, these do not fade and may actually get darker with age. Laser treatment before age one can often lighten the patch.
Hemangioma (commonly called strawberry hemangioma)
A hemangioma appears at birth as a pale area of skin that, within 2–4 weeks, becomes a red, rubbery nodule. Although they are benign and usually do not require treatment, it may take years for them to go away. Fifty percent of hemangiomas will go away by age 5, 70% by age 7, and 90% by age 9. After they resolve, you may still see a whitened area, scar, or an area of small red blood vessels on the skin.
This is a light brown patch that does not fade or go away. One to two patches are considered normal, but multiple spots (more than 6) can be associated with certain disorders, such as neurofibromatosis type I.
Congenital melanocytic nevus
These dark brownish-black lesions may have hair at their center. They can be small or very large. Large lesions can increase your child’s risk for melanoma as he or she gets older.
The first few days
Many of your infant’s organ systems are still immature and adapting to the new environment. For example, infants may develop a bluish-red blotchy or lace-like pattern on their arms, legs, or trunk when they are exposed to cold air because their circulatory system is still developing. This is very common and disappears as you warm your infant. You may continue to see this response to cold air until 6 months of age.
Many newborns will also develop jaundice, a yellowing of the skin and eyes in the first days of life. Physiologic jaundice is a normal process that can appear at about 24 hours after delivery and resolves within 1 week in full-term infants and within 2 weeks in premature infants. This type of jaundice usually does not cause any problem for your newborn unless the bilirubin level (the substance in the body that causes the jaundice) is very elevated or it does not decrease within 1–2 weeks.
Breast milk jaundice is another type of jaundice that is seen on days 5–7 of breastfeeding and can be caused by low volumes of breast milk. This jaundice peaks at 3 weeks, goes away by 3 months, and usually does not require treatment.
Common rashes that may appear in the first week:
Erythema toxicum neonatorum (ETN)
ETN is a benign condition that occurs in up to 75% of full-term infants. At about 24–48 hours of age, the child develops 1–3 cm red blotches with a tiny blister (vesicle) or pus-filled lesion (pustule) in the center, usually on the face, trunk, arms, or legs. It is uncommon to see on the palms and soles. Infants are not bothered by these lesions and do not appear sick. They clear up by 2–3 weeks of age and do not leave a scar.
Transient neonatal pustular melanosis
Blisters or pus-filled lesions develop on the skin at birth or shortly thereafter. They are primarily seen on the forehead and jaw, but they can appear on any part of the body, including the palms and soles. The lesions heal by day 5, leaving tiny brown patches that disappear by 3 months of age. This condition is seen more commonly in infants with darker skin and is less common than ETN.
The first few weeks
As your child continues to grow, you may see new skin changes as well as some common skin infections. With proper care, the majority of these will resolve on their own:
It is common for infants to begin losing newborn hair during the first few weeks of life, a process called telogen effluvium. No treatment is needed, and most of the newborn hair will be shed by 3–4 months, making way for new hair growth.
Miliaria rubra (commonly called heat rash)
Heat rash is caused by sweat gland obstruction and appears as small red bumps or blisters, usually on skin that is covered by clothes or blankets. To prevent or ease heat rash, avoid overheating, remove extra clothes, bathe in cool water, or use air conditioning in hot weather. Heat rash is benign and will resolve on its own.
Fifty percent of infants will develop neonatal acne during their second to fourth weeks of life. The acne appears as red bumps, pus-filled lesions, and whiteheads on the forehead, cheeks, and nose. It is caused by hormonal changes in the infant and usually goes away by 4 months of age. Neonatal acne is not painful for your child and does not require treatment in most cases. If the acne is severe, your doctor may recommend treating it with benzoyl peroxide 2.5% lotion.
Seborrheic dermatitis (commonly called cradle cap)
Usually developing in the first month, this red, greasy scale is most commonly seen on the scalp and sometimes on the face, ears, neck, and diaper area. It is not irritating or itchy and usually resolves on its own within a few weeks to months without leaving a scar. After softening the scale in a bath or with petroleum jelly, you can gently remove the scale with a brush. You can also soak the scale with vegetable oil overnight to soften it and shampoo in the morning to remove it. If these treatments do not work, talk to your child’s doctor about medicated shampoos and creams that may help.
Diaper dermatitis (commonly called diaper rash)
Most babies will develop a diaper rash at some point in their first few weeks and months of life. This rash is caused by prolonged wetness, which makes the skin more sensitive to irritants such as urine and feces, and more prone to infections, most commonly yeast infections such as Candida. Irritant dermatitis is the most common cause of diaper rash and appears as red patches on the genitalia and buttocks, which are often tender and inflamed. Candidal dermatitis appears as brighter red patches with smaller red bumps surrounding the larger lesions.
To treat diaper rash, expose the area to the air as much as possible to dry it out, and change diapers frequently to decrease moisture on the skin. Gently clean the area with water, unscented baby cleanser, or mineral oil, and use ointments such as zinc oxide paste or petroleum jelly with each diaper change to protect the skin. In some cases, your doctor may recommend a mild steroid ointment such as hydrocortisone 1% or 2.5% to decrease the redness and inflammation. Candidal dermatitis can be treated with antifungal creams prescribed by your child’s doctor.