A Complete Guide to Newborn Rashes

A newborn’s skin may experience changes within the first several weeks of life. These changes become a cause of concern for parents, though many are not actually worrisome. What are the most common newborn rashes, what causes them, and what are the available treatment options?

Most common newborn rashes:

Rashes can affect every newborn to some degree. Thankfully, they are usually self-limiting or resolved independently and do not require any treatment. Most rashes do not cause any discomfort for your baby. However, some skin conditions may require further investigation or cause your newborn pain. Let’s look at each rash individually.

Erythema toxicum neonatorum

Erythema toxicum neonatorum (ETN) impacts 40–70% of newborns. ETN usually develops before discharge from the hospital on the second or third day of life. The rash is characterized by macules and papules — flattened discolorations or raised spots — surrounded by a reddened area. The reddened macules and papules may develop into small, blister-like spots. The rash generally occurs on the face, abdomen, and extremities.

The cause of ETN is unknown. One theory describes an immune response by the infant to microbe growth. A few studies have supported this theory. ETN usually disappears within 7 to 14 days, but can reappear within the first month of life. This rash does not require treatment and is not associated with negative outcomes.

Baby acne (acne neonatorum)

Baby acne, or acne neonatorum, affects up to 20% of newborn infants. Baby acne resembles the acne we may associate with adolescents. The rash causes raised, inflamed bumps that may develop into whiteheads. It usually occurs anywhere on the face. Baby acne appears after the first month of life and can continue until four months of age.

The cause of baby acne is unclear. The rash may be caused by the relationship between the infant’s sebaceous glands — an oil-secreting gland within hair follicles — and maternal and infant hormones.

Usually, baby acne requires no treatment. This rash resolves on its own without consequences. Medicated creams may be prescribed in severe cases. It is crucial not to pinch, squeeze or vigorously rub any baby acne.

Milia (milk spots)

Milia — often called “milk spots” — impacts up to 50% of newborns. Tiny, white bumps usually appear on the upper cheeks, nose, and chin. No redness or inflammation is associated with milia. Milia are generally present at birth, but may appear later in preterm infants. Milk spots are caused by keratin — a protein found within the skin — that has been trapped in hair follicles. No treatment is necessary for milk spots or milia, which tend to disappear by the first or second month of life.

Cradle cap (infantile seborrheic dermatitis)

Infantile seborrheic dermatitis (ISD) is a familiar rash, often called cradle cap, because it often occurs on the scalp. The rash can appear on the face, ears, neck, and armpits and may quickly spread to the diaper area. Cradle cap is characterized by redness and greasy appearing skin scales. However, only redness may present in skin folds and the creases of joints. ISD can appear around the second week of life and may last until 4 to 6 months.

The cause of cradle cap is unknown. Some studies have identified a strain of yeast as the culprit. Hormones may also be a contributing factor. Seborrheic dermatitis is similar in appearance to both atopic dermatitis and psoriasis. Atopic dermatitis, or eczema, often coexists. Rapid onset of ISD may also be concerning and may indicate immunodeficiency. In this case, a pediatrician or dermatologist evaluation is essential. The physician will assess the rash's appearance, newborn onset age, course of the rash, and location.

Cradle cap, like many other newborn rashes, heals on its own. “Watchful waiting” is frequently the recommendation by pediatricians. An emollient or oil such as white petrolatum or coconut oil can be applied to the greasy scales and then gently removed with a soft brush. Other treatment options are available, but should be used cautiously due to safety concerns.

Baby eczema (atopic dermatitis)

Baby eczema is a less common skin rash that affects approximately 13% of all children under 18. This rash can cause discomfort for your baby. Atopic dermatitis is a type of eczema characterized by dry, itchy scales or bumps that can leak fluid. Eczema in newborns usually appears on the head and cheeks. It may also appear on the elbows and knees of older children.

Eczema usually first appears around six months of age, but can occur earlier. Atopic dermatitis has no known cause, but many factors may play a role in its development, including soaps, cleansers, lotions, food allergies, and dry air. Eczema can have exacerbations or flare-ups in response to specific triggers. Baby eczema may require treatment. Evaluation by a pediatric dermatologist helps determine the best course of action. Prescribed medication creams can be an option, but the best way to treat baby eczema is to prevent flare-ups by avoiding triggers. It may take some time, trial and error, to discover your baby’s triggers.

Diaper rash (diaper dermatitis)

Nearly every baby or child will experience some degree of diaper rash or dermatitis in their early life. It is one of the few expected newborn skin conditions that can cause discomfort or pain for your baby. This rash occurs in the diaper area and appears as reddened, inflamed skin that may have raised bumps or bleeding spots. Severity can greatly vary. Diapers do not cause diaper dermatitis. Factors associated with the diapering area cause the rash.

Urine or stool that sits on the skin for prolonged periods can cause mild to significant irritation. These irritants on a baby’s sensitive skin lead to a skin barrier breakdown. Microbial infections can further complicate diaper rash, including Candida albicans (yeast), Staphylococcus aureus, Streptococcus species, E. coli, and Bacteroides. After introducing solids, you may identify specific foods that cause more irritation than others. It is during these older months that diaper rash may be more prevalent.

The best way to treat diaper rash is to prevent it, but that is not always possible. Parent education is also critical. Studies show that effective skin care and improvements in diaper technology have reduced the frequency and severity of diaper rash.

Remember these recommendations to prevent diaper rash:

• Frequent diaper changes
• Use of disposable, breathable diapers
• Gentle cleansing of the diaper area
• Use of protective emollients or creams to create an additional protective skin barrier
• Awareness of the particular foods that irritate

Diaper rash usually responds well to in-home treatment. Using baby wipes free of fragrances, perfumes, essential oils, soaps, and detergents is preferable. If the rash is significant and painful, bathing the stool or urine away in a bath may ease the discomfort your baby experiences. Emollients such as zinc oxide, petrolatum, lanolin, or other oils improve skin barrier function. They should be applied in a thin layer with special care around skin folds to avoid emollient build-up. The goal is to help the skin heal quickly and avoid additional irritation. Rashes complicated by microbial infection or contact dermatitis require professional evaluation and medicated creams. Do not hesitate to contact your pediatrician if you are concerned about your baby’s diaper rash.

Your pediatrician has the ability to counsel and reassure about any rash your newborn may be experiencing. Education and awareness are helpful in calming concerns you may have as a parent. Thankfully, the most common newborn rashes heal on their own with minimal treatment.