Common Neonatal Rashes

Common Neonatal Rashes - What it is

SEBORRHEIC DERMATITIS

Seborrheic dermatitis is a common skin condition which affects infants before 3 months of age.

It is caused by hyperactive oil glands due to circulating maternal hormones after birth. A natural yeast called Malassezia (Pityrosporum) grows in the increased oily secretion, resulting in inflammation (redness) and overproduction of skin cells (scaling).

Infants usually outgrow this condition by 6 to 12 months of age. Some babies with seborrhoeic dermatitis will develop atopic dermatitis (eczema), especially if there is a family history of eczema, allergic rhinitis (sensitive nose) or asthma.

NEONATAL ACNE:

Neonatal acne is quite common and affects about 20% of babies. It occurs as a result of maternal hormonal stimulation of hyperactive sebaceous (oil-secreting) glands.

It appears from a few weeks to few months of age.

DIAPER DERMATITIS:

Diaper dermatitis, or diaper rash is a skin condition where the skin covered by diapers develops a rash.

It is one of the most common skin problems in infants and young children.

Diaper dermatitis occurs due to several different factors. The most common cause is irritation by urine and faeces, especially if there the baby has loose stools or diarrhoea, or the diapers are not changed frequently. Tight fitting diapers can cause friction over the folds of the groin area. Secondary infection with bacteria and candida yeast is also common in the groin area.

Some skin conditions e.g. seborrheic dermatitis or atopic dermatitis can affect the diaper area. These can be worsened by the abovementioned factors as well.

Common Neonatal Rashes - Symptoms

SEBORRHEIC DERMATITIS

It commonly affects areas of the skin rich in oil glands, such as the scalp, eyebrows, ears, back of the neck and diaper area.

On the scalp, it appears as whitish, oily skin flakes, often referred to as "cradle cap". In more severe cases, the scalp can have dense, thick, adherent yellow scales and crust.

On the other affected areas, the skin appears red, greasy, flaky, and itchy.

NEONATAL ACNE:

Neonatal acne occurs on the face, especially the cheeks and forehead but can also be seen on the scalp, upper chest and back.

Small red bumps, sometimes with pus are usually seen. Sometimes there are black heads and white heads.

DIAPER DERMATITIS:

Most infants develop diaper dermatitis at some stage, most commonly between nine and 12 months.

The skin in the diaper area becomes red. If severe, erosions may develop. If caused by irritation from stools and urine, usually the convex surfaces of the diaper area are affected. If caused by tight-fitting diapers, the folds are usually affected. If there is secondary fungal infection, "satellite" lesions and small pustules are seen. If there is secondary bacterial infection, the skin can become oozy and crusty.

Common Neonatal Rashes - How to prevent?

DIAPER DERMATITIS

Frequent diaper change can reduce contact between the skin and urine or faeces.

Clean the skin in the diaper area gently and carefully. Dry by patting with a soft towel instead of rubbing the delicate skin.

Gentle cleansing with warm water and a soft cloth is usually sufficient. If soap is desired, a mild, fragrance-free soap substitute or bath oil is recommended.

If baby wipes are used, choose a brand that is alcohol and fragrance-free. Baby wipes are not recommended if the skin becomes irritated or develops open sores.

Dried faeces can be loosened with mineral oil applied to a cotton ball.

Common Neonatal Rashes - Causes and Risk Factors

Common Neonatal Rashes - Diagnosis

Common Neonatal Rashes - Treatments

SEBORRHEIC DERMATITIS

Scalp:

Wash your baby’s hair daily with a mild, tear-free baby shampoo.
If there are thick scales, application of olive oil 30 minutes to 1 hour before rinsing off with shampoo can be helpful in softening the scales.
If the scales do not loosen easily, you can use a soft brush or towel to gently remove the scales after softening.
Do not pick the scales as this may increase the risk of infection.
For more severe involvement, your doctor may recommend an anti-fungal shampoo, mild steroid lotion and a moisturiser.

Rest of body:

Cleanse with a gentle soap or moisturising bath oil daily.
Anti-inflammatory creams such as a mild topical steroid lotion, anti-fungal creams and moisturisers may be prescribed.
Frequent diaper changes if nappy area is affected.
If the rashes do not improve after a few weeks, do make an early follow-up appointment with the KKH Paediatric Dermatology Clinic to re-assess.

NEONATAL ACNE:

Neonatal acne is usually self-limiting, and will resolve after three to six months of age, without scarring.

Treatment is not usually necessary except in patients with extensive lesions.

In rare cases where the condition persists beyond 6 months of age, further investigations may be necessary to exclude other medical causes. This will be reviewed and decided by your physician.

DIAPER DERMATITIS:

Frequent diaper changes or leaving the child out of diapers for short periods of time would be helpful.

Gentle cleansing with tepid or warm water, and a soft cloth is usually sufficient. If soap is desired, a mild, fragrance-free soap substitute or bath oil is recommended.

Apply a moisturiser or a barrier cream to the skin before each diaper change.

Ensure the diaper area is air dried completely before putting on the diaper.

If the skin is very inflamed or red, a mild topical steroid will be prescribed.

If candida yeast is suspected, a topical anti-fungal cream may be prescribed.

If secondary bacterial infection is suspected, topical antibiotics or sometimes a course of oral antibiotics for five to seven days is prescribed.

Common Neonatal Rashes - Preparing for surgery

Common Neonatal Rashes - Post-surgery care

Common Neonatal Rashes - Other Information

Overview

Article contributed by Dermatology Service, KK Women's and Children's Hospital; Dermatology Service, KK Women's and Children's Hospital

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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