Pearls of Wisdom: Newborn Skin Conditions

shutterstock_28299541We’ve all seen pictures in books and magazines of the perfect newborn, swaddled in a hospital blanket, nestled into her parents welcoming arms. She is as perfect as a rose, with a tiny upturned nose and lovely, clear skin. It’s no wonder that parents are often surprised when their newborns present with a variety of rashes and skin conditions. The Majority of these rashes are harmless and self-limiting, and will resolve on their own or with appropriate treatment.

Normal newborn skin is thin and less hairy than older children and adults. Also, the ratio of skin surface to body volume is high which leads to increased absorption of topical medications.  Frequent manipulation, hot water and harsh soaps are some of the factors that lead to irritation and skin breakdown. Once there are breaks in the skin, these become portals of entry for bacteria, leading to serious skin infections.  Frequent use of moisturizers helps re-hydrate the skin and prevents excessive dryness and skin infections.

There are a number of benign skin changes that are seen in the first few weeks after birth. The more common ones include the following:

* Salmon Patches (also known as “stork bites”) are vascular stains frequently found on the nape of neck as well as the glabella (space between the eyebrows and above the nose) where they are called “angel’s kisses.”  They are found in 70% of white babies and 59% of African American newborns. Although these lesions may fade over time, 25-50% may persist into adulthood.

* Hemangiomas initially appear as flat red patches that darken and spread with time. They may be elevated , bright–red or violet in color, depending on how deep they are. Rapidly growing lesions may require steroids and/or laser therapy, although many will just fade and regress with age.

shutterstock_113526559* Infantile or Neonatal Acne usually appears at 2-4 weeks of age and resolves by 6-8 months. Experts believe that this is an inflammatory response to an organism called Pityrosporum yeasts.  This skin condition usually does not warrant therapy unless very severe in which case, a 2.5% benzoyl peroxide treatment as well as topical antibiotics may be prescribed.

* Atopic Dermatitis (Eczema) is an extremely common itchy scaling disorder that appears between 4-6 weeks of age. It may present on the cheeks, trunk, in bends of elbows and behind knees. Many babies either have a family history of eczema and/or allergies. A good 60% of babies who have eczema or atopic dermatitis outgrow it. Medications can help control flare-ups but does not cure it. I usually recommend avoiding long, hot baths and applying moisturizers daily. Sometimes, we recommend non-steroidal or steroidal creams and antihistamines for itch.

shutterstock_56934568* Seborrheic Dermatitis is the most common scaling skin disorder in infants. It appears immediately after birth, usually affecting the scalp (called “cradle cap”), behind ears, and on the face. It appears like well-demarcated, confluent red patches with greasy scales. This type of dermatitis does not itch and usually resolves by 3-6 months of age. Treatment depends on severity; usually your doctor may prescribe antiseborrheic shampoos that contains zinc and selenium sulfide. Using mineral oil before shampooing may help remove the scales. In the presence of a superimposed fungal infection with Candida, an anti-fungal may be prescribed.

* Diaper Dermatitis is a nonspecific term that pertains to all skin eruptions in the diaper area. Irritant diaper dermatitis is secondary to a variety of factors that include fecal enzymes that erode the skin barrier, prolonged exposure of skin to moisture, and the presence of ammonia in the baby’s urine. Babies with diarrhea and those taking antibiotics also are at risk. Mild cases can be treated with topical zinc oxide paste or a petrolatum emollient which acts as a protective barrier against soiling elements. Frequent changing of diapers is recommended to reduce moisture and time exposed to extrinsic factors. In severe instances, 1% hydrocortisone cream applied after diaper changes may be given.

Plain water with or without a mild soap should be used to gently clean the baby’s skin. Your infant does not require frequent bathing if you wash the diaper area thoroughly during diaper changes. Bathing babies too frequently dries out their skin especially if soap is used. Patting her dry opposed to rubbing hard, followed by application of a fragrance-free, hypoallergenic, moisturizing lotion immediately after bathing can help prevent dryness and eczema. In other words, be gentle with your baby’s skin and avoid substances that have triggered skin rashes or irritations in the past. When in doubt, do not diagnose and treat baby without visiting your pediatrician, who can decide whether the rash is a harmless, benign lesion or something that needs referred to a dermatologist.

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

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Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

“Itchy Spots” (or Eczema, as it is Called Elsewhere)

Four years ago, the extent of my knowledge regarding eczema was its existence as some kind of skin rash. Having worked with a person who had psoriasis, I somewhat (incorrectly) equated the two and felt bad for people who dealt with them but didn’t give them much thought myself. So, when my son had a circular patch of red, bumpy skin on his arm, I never considered eczema but thought it was ringworm. Daycare thought the same and the nurse at my son’s clinic confirmed the suspicion and said to use Lotrimin on the area. A few days of Lotrimin, however, brought about no change and my mother, a RN, was visiting, so I asked her opinion. She thought it looked like “contact eczema” and suggested we change laundry detergents.

This change seemed to do the trick at first, but it wasn’t long before what came to be called “itchy spots” in our house started popping up all over my son’s arms and legs and occasionally his back and stomach. All of these spots were circular in nature (similar to ringworm), not like the eczema photos I’d seen on posters in the doctor’s office, and daycare was concerned that this was some type of fungal infection and therefore contagious. So I did some research and saw a pediatrician and it turned out eczema appears in more than one form and the form my son had was Nummular Dermatitis or Nummular Eczema which is often misdiagnosed initially as ring-worm due to its circular appearance. So, no ringworm (phew), but still the unpleasant “itchy spots” remained. Typical eczema remedies – cortisone on the “itchy spots” when they were red and Aveeno when they were not, no use of soap (just Aveeno bath wash), free & clear laundry detergents, and no bubble bath became the routine at our house. Still, for a long time my son would go through periods where he had these horrible “itchy spots” that he would often pick at and worsen. The crease on the inside of his elbow was particularly bad and I had difficulty getting the eczema to clear from that area. Of course, this is also an easily accessible spot to itch, so I took to covering it with Band-aids to keep my son from picking at it.

ScratchingIn the meantime, I kept researching and came across a link between eczema and milk protein allergy. I spoke with the pediatrician about the possible connection between that two, but was told that it was unlikely and there was no proof of a connection (the same thing I was told about my son’s reflux and a possible milk allergy) and so, we just continued our “itchy spot” routine. It wasn’t until this year, as my son’s “itchy spots,” all-but disappeared and then were gone, that my daughter (who is eczema free) was diagnosed with a milk protein allergy. When we saw the specialist regarding this, the conversation with him resulted in the following conclusions:

1. According to the specialist, it was surprising that my daughter did not have eczema given the obvious milk protein allergy.

2. Milk protein allergies are often the cause of night-waking (something my son has always struggled with).

3. My son likely had a milk protein allergy which caused or at least aggravated his reflux and eczema and was no longer struggling with it because he had outgrown the allergy (as most children do by the time they are six) or reduced his milk intake to a level where it was not affecting him.

Having one of those, “if I had only known then” moments, I wished I had just taken my son off dairy a few years ago to see what happened despite the pediatrician’s assurance that a milk allergy was not likely. It certainly would’ve been nice to ascertain a connection between the two four years ago, but hindsight is always 20/20. Still, I would be curious to know how many out there have found an obvious connection between their child’s eczema and a food or other allergy. I also encourage any of you dealing with eczema to explore the possibility of it being caused from a food allergy – and follow your instinct even if your doctor says there is little chance…see a specialist or try eliminating dairy. It might be worth it.

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About the Blogger:

Hi! My name is Shawna. I am a married mother to two adorable children and love being a mom. My children throw me unexpected surprises more often than I can count, but I wouldn’t change that for the world. Thanks for reading!