Did you know that skin is the largest organ in the human body?  It serves many functions on our behalf, and especially in our babies and young children.
Our skin is the first line of defense against viruses, bacteria and other nasty bugs out there. Intact, moist and healthy skin shields us from many illnesses. Skin also prevents our bodies from losing excessive fluids and keeping our internal hydration intact. In addition, it almost single-handedly helps keep our internal body temperature consistent – goose-bumps help us retain heat, and flushing and sweating help us lose heat.
Skin is responsible for sensation – heat, cold, vibration and touch are all wired into our skin. Skin also is responsible for manufacturing vitamin D (which helps feed calcium to our bones), storing fats and water, and keeps us from essentially leaking nutrients. We are water resistant, naturally!
In essence, skin is our body’s superhero, and even though it looks like there might be a problem early on, there are several skin conditions of infancy that are expected, common, and self-resolve that almost always concern parents. So I wanted to review a few of the most common skin-related eruptions we see in newborns in our offices and give you some pointers on when, and when not, to worry.

7 Common Skin Conditions Babies Have

  1. Erythema Toxicum – sounds scary, but it’s not. It’s a typical flea-bite-like eruption that occurs in the first few days of life. It can appear on the face, or entire body. It comes and goes over the first couple of weeks of life. Think of it as a TEMPORARY adjustment reaction for skin that has transferred from the moist environment of the womb, to the dry environment of the outside world. It doesn’t hurt, it goes away on its own, but it comes as a surprise to many new parents
  2. Seborrheic Dermatitis – a greasy, scaly, red and shiny eruption that occurs on the scalp (called cradle cap), behind the ears, on the forehead, and in moist folds. It’s typically from the excessive production of sebum (skin oils) that accompanies the many hormonal changes in babies in the first several months of life. It can be unsightly, and can be uncomfortable for baby, especially if in skin folds. Cradle cap is typically treated by some local friction with a wet washcloth, and combing out the scales. Areas affected in skin folds need to be kept dry, and if persistent, your doctor may recommend a brief treatment with topical hydrocortisone, which calms this down very quickly.
  3. Baby Acne – aww….your little one is just starting to grin, you’ve got your camera out, and suddenly, you see zits! Zits??? In both male and female infants, a “mini-puberty” occurs at about 6-12 weeks, with an accompanying spike in testosterone and estrogen – this occurs because there is temporary development in the testicles and ovaries before they go into dormancy until real puberty occurs. With this spike may come some baby acne (typically on the cheeks). It goes away without any treatment, and only in the rarest circumstances persists beyond a couple of months. If it does or worsens/spreads to other body parts, best to consult your baby’s doctor.
  4. Mongolian Spots – these are birthmarks that actually develop and deepen in color and distribution over the first few weeks of life. They may not be so obvious in the first few days of life and then suddenly appear. They look like pale grey-ish blue bruises, so it’s easy to understand why parents freak out. What are they? Think of your baby’s skin as a coat of pigmented paint. Now imagine that there’s a little uneven pigment that stands out here and there. Melanin (the skin’s natural pigment) may be a little more concentrated in some areas of skin shortly after birth – like the buttocks, ankles, wrists. This is especially seen in children of color, whether black, brown or yellow, but can also be seen in Caucasian children – especially in cultures with dark hair and eyes, like those of Eastern European descent. The good news is that these spots fade as skin thickens and matures. It’s just important that we document the spots so that well meaning health care providers or teachers don’t misinterpret them as bruises.
  5. Diaper Rashes – skin under the diaper is assaulted dozens of times a day with urine and baby poops. Due to the thin nature of baby’s skin, coupled with the occlusive moist nature of life under the diaper, it’s easy to understand why this area can rash up literally in minutes. So getting into the good habit of whisking off poopy diapers immediately is one I encourage my parents to do. Wiping off the poop with a moist soft cloth, wipe or quilted soft paper towel, followed by drying the area, and replacing with a clean diaper is usually the best strategy. Early on, though, with some babies producing 10-12 dirty diapers a day, the area around the anus may break down and look raw or red. Your doctor may recommend a barrier cream to protect that area, and even letting baby lay out “commando” from the waist down (on a layer of absorptive towel) to air dry.
  6. Candida – It’s rare that we need to prescribe treatment for diaper rash unless we see Candida – basically a yeast infection in the diaper region. Why does that happen? Yeast lives on all of us, it’s a normal part of our skin’s natural germs. However, if baby is on antibiotics (or you are and are breast feeding), the natural balance of germs on the skin is upset and yeast then takes over and thrives in the diaper area. How do we know if it’s yeast? Typically the rash is a large area of bright, shiny red skin with “satellite lesions” – red dots and blots on the edge. Baby is typically a little irritable as these itch, and in older babies, they may try to scratch beneath their diapers. This condition requires an anti-yeast medication that will be recommended by your doc.
  7. Pacifier/Drool Rashes – anywhere where there is excessive buildup of moisture on a baby’s skin is a potential location for these kind of rashes. Beneath the confines of a pacifier lies an accumulation of saliva and perhaps a little spit up food – providing a perfect environment for breakdown and redness around the mouth. Gravity may take that saliva and food down to the neck folds. Before you know it, your baby’s got a funky smelling neck and you’ll now know why. So make an effort, after feeding and burping, to take a clean wipe, lift your baby’s chin and give her neck a little swoosh, followed by drying gently. She’ll thank you for it.

I hope this little primer will help you get through the first few months with your new baby. Fortunately, if you are seeing your primary healthcare provider for regular checkups, rarely do any of these conditions get out of hand. If you are worried about what you are seeing on your baby’s skin, place a call to your doc. He/she may want you to snap a photo on your phone, and often we can lay worries to rest. That picture is worth a thousand words, and often saves an office visit and copay!

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