Most rashes in newborns are entirely normal and are of no concern. Small white bumps on an infant’s face and nose are called milia. These require no treatment. They will disappear in a month or so. Neonatal acne which resembles acne in older children occurs in infants due to maternal hormone stimulation. This, too, will fade with a little time. Birthmarks are common in babies, especially over the eyelids and over the back of the neck. These should be discussed at a routine office visit.
Any purple or bruise-like rash which cannot be explained by simple bruising should be evaluated right away.
Diaper rashes are usually due to either irritation of the skin from a wet diaper (ammonia) or to a yeast infection in the diaper area. A yeast can grow on the skin in moist areas. When a diaper rash appears, try especially hard to keep the skin clean and dry. Change the diaper as soon as it is wet or soiled. It is a good idea to put zinc oxide ointment (Desitin) or Vaseline in those areas. If the rash is due to irritation from urine (ammonia), this treatment will be quite effective and the rash should resolve. However, if the rash does not improve with this treatment, contact your physician.
Eczema is a skin condition seen in allergic people, which causes the skin to be dry and sensitive. Sometimes, this can lead to a rash over most of the body which is scaly, red, itchy and sometimes even broken open or weeping. Eczema tends to occur in people with a family history of allergy (asthma, hay- fever, eczema, and/or itchy, watery eyes). The treatment of eczema is primarily directed at keeping the skin will hydrated. To do this, it is recommended that the mildest and least amount of soap possible be used. Examples of mild soap are: Dove, Tone, Purpose and Neutrogena. Soap washes away the normal oils of the skin and makes eczema worse. In addition to this, applying Moisturel or Eucerin lotion to the affected skin to further seal the skin from continued water loss can be helpful. If your child’s dry, sensitive skin continues to be a problem despite the above measures, you should contact your physician.
Hives and Allergic Rashes
Hives are red, raised rashes in various sizes, which are usually due to an allergic reaction. The rash seems to move to different areas of the child’s body. It is often associated with itching and sometimes with swelling of the hands and feet. The rash is usually not dangerous, but can be uncomfortable. Hives can be caused by anything that the child has eaten, breathed or come in contact with. Hives are almost never due to something that is new in the diet. Usually, the child has been exposed to the very thing that caused the hives sometime in the past with no reaction.
The treatment of hives is to remove what is causing the rash and make the child comfortable. Of course, to remove what is causing the rash requires that it be identified, which can be very difficult. Write down everything that your child had to eat or was exposed to during the 24 hour period prior to the break-out of the rash. If the hives recur, this should be done again. With each episode, the list should be compared to try to identify the agent responsible.
Benadryl should be given to your child. This will help resolve the rash and control the itching (see Dosing Guide). If your child develops a breathing problem associated with this rash (very rare), the child should be seen immediately.
If your child has come in contact with poison ivy or another irritant, it is important to wash the involved area thoroughly with soap and water to remove the poison ivy toxin. You should treat poison ivy (contact dermatitis) with three types of treatment to speed healing and comfort the child. First, cortisone medicine is quite effective in decreasing the inflammation due to poison ivy. Over-the-counter, 0.5% hydrocortisone cream or ointment (Cortaid) can be helpful. If the rash is particularly severe, you should contact your physician. A stronger cortisone cream or ointment or an oral form of cortisone may be prescribed. Elixir can be used to control itching (see Dosing Guide). Lastly, Calamine lotion and Aveeno baths are sometimes helpful for itching. As with other rashes that cause itching, you should trim your child’s nails to prevent scratching and scarring. You can not catch poison ivy by touching the rash of someone who has contracted poison ivy (contact dermatitis). Contact dermatitis is not contagious.
Rashes Due to Drugs
If a rash develops while your child is taking medication, the medication should be stopped and your physician notified. See section on allergy in this booklet.
Seborrheic Dermatitis(Cradle Cap)
Cradle cap is a red, scaly rash on the scalp and body of newborns and infants. This is caused by excessively oily skin. The use of baby oils can make it worse. Seborrheic dermatitis (cradle cap) is treated by removing the scales with an anti-dandruff shampoo such as Sebulex and scrubbing with a soft baby brush. If the rash on the body is particularly severe or if the cradle cap does not resolve with the dandruff shampoo, contact your physician.