What is normal?Suggestions for skin careCommon skin conditions
What is normal?
A baby’s skin undergoes many changes in the time between birth and 3 years of age, with the newborn infant needing to adapt quickly to the world outside the womb. At birth, babies are covered in a white, waxy substance called the vernix. Once this is wiped off, the baby’s skin is exposed to the environment for the first time.
You may notice that a baby’s skin is somewhat different from that of an adult. As the skin at this stage of life is very new, it is sensitive, easily irritated, and prone to drying out. When exposed to the cold, it is not unusual for red blotches to appear over the infant’s skin (mottling). These are normal and will disappear once the baby is warmed. Some newborns are covered in a fine, downy hair called lanugo. This is more common with preterm infants, and begins to fall out soon after birth.
It is not unusual in newborns to see many tiny, yellow bumps over the nose and cheeks. This occurs in at least half of all babies and is caused by an overgrowth of the glands in the skin that produce oil (sebum). This is nothing to be concerned about and will disappear within 6 months. Equally as common in the newborn is acne, thought to be caused by hormones passed from mother to child while in the womb. Again, this does not require treatment and will usually disappear before 3 months of age.
The majority of babies will experience reddish, blotchy patches with a little white spot in the centre (erythema toxicum neonatorum). These usually begin within 24-48 hours after birth and resolve over the next few weeks.
Suggestions for skin care
Although infant skin is very good at adapting to its environment, it is not yet fully mature. This means that extra care should be taken to avoid substances that may irritate or dry out your baby’s skin. It is recommended that infants be bathed using plain water, with this usually only needing to be done once or twice per week. Given that the face, hands and nappy area tend to get dirty easily, these may be cleansed daily using a small amount of mild, unscented cleanser. As a general rule, the fewer products you use on your baby’s skin, the better.
Depending where you live, winter may be associated with low humidity, and cold weather requiring household heating. These factors can dry out a baby’s skin. It is helpful to apply a simple, unscented moisturising cream such a sorbolene or aqueous cream, from a tube or a jar after the bath, once daily to the trunk and limbs. In the warmer months, a lighter moisturising lotion in a pump pack may be preferable. Recent research into atopic eczema has highlighted the importance of skin barrier functioning. By keeping the skin well moisturised, the barrier can function optimally. Studies are currently being performed to see if regular moisturising in infancy will prevent the onset of eczema and allergies.
When the ultraviolet (UV) index is 3 or more, ensure that the baby’s skin is kept out of the sun as much as possible: the use of hats, appropriate clothing and sunshades is important. For those less than one year, use of sunscreens containing physical rather than chemical sunscreen agents, is recommended.
Common Skin Conditions
Because their skin is so new, babies can be prone to a range of conditions. These can include drying out, eczema, reactions to food allergies, nappy rash, sucking blisters and mouth rash. Some of these conditions can and will pass as a baby’s skin matures.
Hair loss over the first few months of life is not uncommon in an infant. It may be gradual or sudden, and commonly occurs at the back of the head. It is usually nothing to worry about and will grow back with time. However, if the hair does not grow back, or the hair loss is associated with other skin changes such as black dots or scaly skin, consult your doctor.
Viruses may present in the young and include conditions such as hand, foot and mouth disease, slapped cheek disease (Parvovirus) and the initial presentation of herpes simplex or cold sores, which can often cause severe oral symptoms. These conditions are usually diagnosed by general practitioners. A particularly severe although rare condition in infancy is Kawasaki disease, which may present with a fever and rash but be associated with heart problems.
Rashes around the mouth may occur when the child is learning to eat and feeding is messy! In addition, dribbling is common especially when teething. A greasy moisturiser like Vaseline™ applied to the area overnight may be helpful.
Birthmarks are extremely common and can be many different colours and shapes, including black or brown (congenital melanocytic naevi), red, and pink (port wine stain, strawberry haemangioma). They are rarely of any medical concern.
Another common type of birthmark is a stork bite (naevus flammeus nuchae), easily identifiable as a faint pink/red patch on the back of the neck or head. Stork bites are found in 25-50% of newborns and are usually temporary.
However, any birthmark that is changing or is that is obscuring the eyes (and may interfere with the development of vision) must be assessed early. Vascular birthmarks growing rapidly may be amenable to treatment with medication, or sometimes laser.
Food allergies may present in the very young, even when babies are being breast-fed, and may aggravate eczema. Allergenic foods include eggs, peanuts, cow’s milk, soy, seafood and oranges. However, current recommendations are to expose infants to small amounts of solids from the age of four months, since it appears that delayed introduction of foods may facilitate the development of allergies.
Nappy (diaper) dermatitis refers to a rash in the nappy area caused by contact with skin irritants, such as urine and faeces. The skin around the nappy area appears red and moist, and may be tender.
Frequent nappy changes and gentle cleansing with warm water will help prevent the condition developing in the first place. Use of old-fashioned occlusive zinc and castor oil creams help prevent irritation.
Occasionally, Candida (thrush) infection may complicate the picture, requiring use of antifungal creams, which are available from a pharmacy (over the counter). In severe cases, prescription anti-inflammatory creams may help.
Fortunately, the widespread use of increasingly absorbent disposable nappies has reduced the frequency and severity of nappy dermatitis. Rarely, reactions to fragrances and preservatives in moist baby wipes may occur, causing dermatitis in either the infant or carer. Use of hypoallergenic varieties is recommended.
Eczema and seborrhoeic dermatitis (salmon-pink patches that are non-itchy) may also occur in the nappy area.
Eczema (atopic dermatitis) is common in infancy and early childhood, affecting 15-20% of children. It is characterised by an itchy, red rash, and the skin is often dry and thickened. Areas most commonly affected include the joints (e.g. elbows, knees, wrists and ankles), face and neck.
It is not contagious – that is, it cannot be spread from one person to another.
Management includes avoiding skin irritants such as soap, and the frequent application of moisturising cream, the greasier the better. Heat may be an aggravating factor and cause the baby to scratch more at night.
Make sure that sleeping conditions are not too hot. Wet dressings may be very helpful to soothe the skin. Babies with eczema are more likely to develop skin infections, and may need treatment with antibiotics.
Usually, treatment of eczema requires use of prescription anti-inflammatory creams or ointments, which your general practitioner or dermatologist can prescribe. Topical corticosteroid creams or ointments are safe for babies and young children and by treating eczema aggressively, the duration of a flare up is often reduced.
For many, knowing how to manage or control eczema is the key, as there is no complete cure available.
Sucking blisters are often seen in the first few weeks of life, and may even be present at birth.
As their name suggests, they are caused by the infant sucking on a particular area of the body, e.g. the forearms or fingers. Intact blisters (still full of fluid) may be seen, or all that may be left is a dried crust of skin. These are not dangerous and heal within a few days.