Skin Lesions and Newborn Rashes all you need to know about
Rashes are extremely common in newborns and can be a significant source of parental concern. Most of rashes are transient and benign and some require additional workup. Some of commom benign skin lesion in newborn include erythema toxicum neonatorum, milia, miliaria, seborrheic dermatitis, neonatal acne, nappy rash, Mongolian spot.
Erythema Toxicum Neonatorum
It has onset in the second to third day of life, characterised by a central whitish to yellowish papule surrounded by a halo of erythema, mainly over the trunk but also in the limbs and face. Lesions may intensify or coalesce particularly in response to local heat. They wax and wane over the ensuing 3 to 6 days.
These commonly occur on the face and scalp, and consist of tiny white papules which are usually discrete. They can however occur anywhere, and may be present at birth or appear subsequently. They usually resolve within a few months without treatment.
Miliaria is commonly seen secondary to thermal stress, particularly with crops of lesions over the face, scalp, and trunk. In neonates, there are two forms:
1. Miliaria crystallina (see image to the left), in which there are superficial vesicles which are 1-2mm in diameter.
2. Miliaria rubra (also called “prickly heat”) results in papules and pustules. It is important to ensure that the baby is not over-wrapped, and once the heat stress is removed the lesions usually resolve quickly.
Seborrhoeic dermatitis primarily affects the scalp and intertriginous areas. It is most common in the first 6 weeks of life, but can occur in children up to 12 months of age. Involvement of the scalp is frequently termed “cradle cap”, and manifests as greasy, yellow plaques on the scalp. Other commonly affected areas include the forehead and eyebrows (as in the photo to the left), nasolabial folds, and external ears. The aetiology is unknown. Treatment includes the use of a mild shampoo, and avoidance of soaps. Occasionally, a mild topical steroid may be indicated.
Neonatal acne may be present at birth, or develop over the first 2-4 weeks of life. The condition consists of pustules over the cheeks primarily, but also involves other areas of the face and the scalp. Neonatal acne resolves spontaneously and without scarring.
Nappy Rash (Diaper Dermatitis)
Nappy rash is a common problem for neonates within the first few months of life. While the exact aetiology of nappy rash is not clear, it is felt to be due to moisture in the nappy environment and from irritation from urine and stool. Many infants will be affected by superinfection with Candida albicans.
Treatment primarily involves the use of a topical anticandidal agent. There should be liberal use of barrier creams, and soiled and wet nappies should be changed promptly.
The photos show a typical Mongolian spot with bluish discoloration. This is a very common benign skin pigmentation occurring frequently in Polynesian, Asian and Mediterranean babies but also, though to a much lesser extent, in Europeans. Although the intergluteal area is the most common site, similar lesions may occur over the trunk or extremeties and at times multiple lesions may be noted. Such lesions have been confused for bruises of child abuse. They gradually fade during the first few years of life.