Guide to the Causes, Symptoms and Treatment of Baby Skin Rash


" To eliminate skin rash on babies, it helps to identify the underlying cause. Review the pictures and descriptions below for conditions which will resolve on their own such as a baby skin rash due to overheating to some that can be fairly serious. If a rash does not respond to treatment or clear up within about three days, make sure you call your doctor, as the cause of the rash may be something that requires medication or testing to reach a specific diagnosis."  

baby skin rashesBaby skin rash on the trunk of body caused by Erythema toxicum neonatorum, a condition seen in healthy infants.

Types of Sin Rashes on Babies

Baby Face Rashes

When a baby is under 6 months of age, there are some common mild baby skin rash conditions that may appear on the face. If you see white pimples, and no accompanying redness, they will go away with no treatment as the baby ages.

Sometimes small red areas will appear on the baby's cheeks or small smooth pimples will appear. Lotions may have minimal effect with the pimples appearing, disappearing and returning again.  This is not cause for alarm and the condition will naturally go away as the baby gets older.

If the red spots on the face are approximately 1/4 to 1/2 inch in diameter with a white pimple at the center,  these can appear and then disappear on their own.  However, if the red spots become filled with pus or the tops crust, then this can be a sign of infection, requiring medical attention.

Cradle Cap (Seborrheic dermatitis)

pics of cradle capPics of cradle cap on Scalp Commonly called Seborrheic Dermatitis.

Also called: Seborrheic dermatitis, Erythematous plaques and Greasy Scales

Erythematous Plaques and greasy scales occur in infants between age 3 weeks and 12 months It is seen in 10% of children, most between age 1 and 2.

It is believed, although not certain that the yeast Malassezia furfur is the underlying cause.

Symptoms

Baby diaper rash caused by seborrheic dermatitis.

Symptoms include scaly skin, that is sometimes greasy and waxy. A skin rash usually appears on an infant’s scalp. However, it may spread to the diaper area and face. Cradle cap Usually affects babies between six and twelve months of age.

Cradle cap symptoms are usually yellowish or white with red inflammation, scaly, greasy/waxy baby skin rash,  and are most often found on the head.  It looks as if the infant's skin is dirty.

  • Oval scaly skin patches
  • Salmon-colored discoloring
  • Greasy scales
  • Erythema (red skin rash)

The condition is commonly seen on the:

  • Eyebrows
  • Forehead
  • Face
  • Scalp (referred to as cradle cap)
  • Trunk
  • Under the diaper
  • Where two skin areas rub together (intertriginous)
  • Areas that flex (armpits, groin, elbows)
baby skin rashCradle Cap Source: Dr. Mahmoud Hijazy/Principles of Dermatology

Treatment

Cradle cap treatment is part of a debate as to whether or not treatment is needed for this condition since it usually goes away on its' own in a few weeks or months. If prescription creams are used it can heal faster.

It looks awful but does not hurt. The most basic treatment is to use soap and water. Mineral oil, baby oil or olive oil gently rubbed in will also loosen the scales, followed by combing the hair.  Wash the scalp 15 minutes after oil application with a mild baby shampoo to avoid clogging the pores. See your Doctor is a stronger treatment is needed. 

If the baby skin rash does not respond to treatment, a topical steroid may be prescribed by a Doctor.

Persistent Diaper Rash

This type of baby skin rash is also called diaper dermatitis. It usually appears on/around the anus, genitals, lower abdomen, and in the folds of skin in the groin area. A usual co-infection is candida, a fungus. It may be the result of a baby being left in a dirty diaper too long, an allergy to plastic pants, disposable diapers, fabric softeners and detergents for cloth diapers, scented powders, and lotions.

8% of infants have this condition.  A Doctor will prescribe medications such as:

  • Topical steroid creams
  • Use of mineral oil or petrolatum (also used for skin itch)
  • Anti-fungal creams (to address any yeast issues)
  • Shampoos that contain Selenium sulfide or Tar

Doctors do not recommend the use of salicylic acid out of concern that it will be absorbed into the body.

baby skin rashDiaper Dermatitis is caused by moisture, urine and feces in the diaper area, usually when a baby is in its 2nd or 3rd month. Source: Dr. Mahmoud Hijazy/Principles of Dermatology

Symptoms

Mild to severe irritation and red splotches that may present itself as small pimples under a diaper. May be combined with a fungal infection called candida. Your doctor will advise you how to treat both diseases at once.

Treatment

Diaper rash treatment involves getting rid of anything that is irritating your baby’s skin. Change diapers often, don't use waterproof pants and clean your baby up thoroughly with plain water and thoroughly pat dry. Wash up only after bowel movements, not every time baby urinates. The key is to keep the baby dry. Stop using lotions or powders to reduce the chance of irritation. If you use cloth diapers, hold off on using fabric softener and don’t change detergents.

If the baby skin rash is in the folds of the skin, it is referred to as being seborrheic. It can be treated with a prescription steroid based ointment.  Diaper rash with fever is due to a staphylococcus germ and require an antibiotic.  Diaper rash in babies can also be caused by yeast (bright red spots, which join together). A yeast rash also requires a prescription ointment.

Avoid cleaning the baby bottom with soap and baby wipes, and use plain water instead. A petroleum and lanolin ointment can help as well.  Leaving the diaper off for a few hours each day can also help to clear the rash.  

Baby diaper rash after diarrhea requires a quick diaper change and also the use of a petroleum ointment with lanolin or a Zinc Oxide cream such as Desitin.  Adding some baby oil to the bath water may also be of help.

Eczema in Babies

Dr. David Hill from Cape Fear Pediatrics explains how Eczema is a skin condition that is a combination of dry skin and allergies, and it is very common in infants who have a family history of allergies. Find out when to use moisturizers to treat baby eczema skin discolaration with help from a pediatrician in this free video on infant medical conditions and health

Baby eczema  is also called atopic dermatitis, infantile atopic dermatitis or infantile eczema. This type of baby skin rash causes itch and  very dry skin. It typically affects children by the age of three.  Eczema usually runs in a family. A medical history of babies with this condition will often show family members with asthma, food and seasonal allergies and allergic rhino-conjunctivitis.

baby rash picsInfantile Eczema appears before age 6 months in approximately 3% of infants. The case shown here is referred to as acute infantile eczema, meaning that symptoms appeared suddenly.
Source: Dr. Mahmoud Hijazy/Principles of Dermatology

Symptoms

Eczema symptoms include itchy, red, raised areas may leak fluid. The baby skin rash may be on the legs, arms, neck or face. In younger children, they can appear in the arm and leg creases, the neck and behind the ears on older children.

Treatment

Eczema treatment typically involves using fragrance-free soaps on the body and when doing the laundry, as well as thick moisturizers to rehydrate the skin (moisturizers that are not sold with a pump, use the type that come in a container such as Eucerin Aquaphor).

If the baby doesn't respond, then a low hydrocortisone ointment can be used.  Once the eczema is healed, switch back to the moisturizer. Mild or slightly more potent topical steroids may be prescribed such as Flogocid. Antihistamines can be prescribed for itching. With infection present due to staph bacteria, antibiotics. Non-steroidal anti-inflammatory creams may be used if corticosteroids don’t work.

Erythema Toxicum Neonatorum (ETN)

skin rash on babyBaby skin rash on trunk of body caused by ETN.

Erythema Toxicum Neonatorum is a condition found in full term and healthy babies. It can be found when born, but will commonly appear in 1 to 2 days after birth.

Erythema means skin redness. Skin lesions start as small raised pimples (papules) and macules (change in skin surface color) before becoming pus-filled bumps (pustules).

They are found on the buttocks, arms, legs, trunk, and face.

A Doctor will need to differentiate this disorder from conditions that result in similar symptoms such as:

  • congenital candidiasis
  • bullous impetigo
  •  neonatal herpes infection
  • staphylococcal impetigo

Diagnosis

A Doctor will diagnose ETN based on skin observation. It can be confirmed with a test called a Wright-stained smear.  If a Doctor finds the presence of a virus, fungus or bacteria then ETN is ruled out.

Treatment

The rash usually heals on its' own in 5 days to 1 week. The condition may become better and worse before it heals. No other treatment is needed.

Neonatal Herpes Simplex Virus (HSV)

Herpes simplex virus in infants can be transferred to the infant before being born (in utero), from birth through the first 4 weeks of life (perintal) or after birth (postnatal).

The disease is further divided into three syndromes:

  • SEM (skin, eye, and mouth)
  • CNS (central nervous system)
  • Syndrome that touches several organs

Symptoms

Baby skin lesions are 2mm to 4mm in size with surrounding red irritated skin. The condition progresses to include crusting and the formation of pustules.

Around the eyes, symptoms of neonatal herpes simplex virus are redness, pain, and excessive tearing.

Ulcers appear around the mouth.

Additional Symptoms

There are several related symptoms that need to be evaluated.

  • Seizures
  • Tiredness (lethargy)
  • Irritability
  • Fever
  • Poor 
  • Respiratory or breathing problems
  • Abdominal distension
  • Sleep apnea
  • Hepatitis
  • Hypothermia (low body temperature)
  • Feeding problems
  • Body tremors
  • Ascites (fluid accumulation)

Conditions with Similar Symptoms

A Doctor will need to rule out the following conditions when making a Herpes Simplex Virus diagnosis in an infant:

  • Adenovirus Exanthem Maculopapular
  • Incontinentia Pigmenti
  • Langerhan's Cell Histiocytosis

Diagnosis

Diagnosis of HSV is done through a series of tests such as a PCR assay or looking at a skin sample. Additional tests are needed if the Doctor believes there is central nervous system involvement.

Treatment

HSV is treated with Parenteral acyclovir.

Prognosis

The prognosis is good if diagnosed early. The condition can result in infant mortality if left untreated.

Infant Impetigo

This is a bacterial skin infection that can be caused by an insect bite, skin injury, malnutrition or a weak immune system.  It is very contagious.  Forms of  impetigo baby skin rash include:

  •  impetigo contagiosa: starts with a flat macule on the face, which is a discolored area that is not raised.  It then develops into a raised blister filled with pus.
  • bullous impetigo: also starts with a painful macule or flat discolored skin area, that also develops into a puss filled blister, followed by a thick crusted skin area.
  • impetigo neonatrum: involves small discolored skin areas. Occurs 4 to 10 days after birth in nurseries.  This type of impetigo can be limited to one skin area or spread across the body.

Infant Impetigo baby skin rash symptoms include small blisters (yellow in color) surrounded by red skin areas.  It is seen in the arm pits, groin and at the edge of the diaper.  The blisters will burst if rubbed or when it ruptures due to a thin covering layer. After bursting the lesion becomes crust covered.  When the crust falls off, it exposes the skin to infection.  

Impetigo neonatrum, in addition to large skin blisters on the face, has symptoms such as fever, diarrhea and green stools.

impetigo on baby faceInfant Impetigo on Baby Face

Immediate medical treatment is needed for this condition with oral antibiotics and antibiotic creams.  Clothes should be disinfected in bleach.

Langerhan's Cell Histiocytosis

Early stage Langerhan's cell histiocytosis starts with skin lesions but can involve other systems of the body either before or just after birth.

Symptoms

Symptoms of Langerhan's Cell Histiocytosis include:

  • red/brown skin lesions (papules)
  • Plaques
  • pustules
  • blueberry muffin syndrome (blue nodular skin infiltrates)
  • hemorrhagic bullae

Locations on the body where symptoms appear include:

  • ends of the arms and legs
  • head
  • neck

Lesions, skin lumps and bumps and rash can be found in one or several areas.  25% of cases show only one lesion.

Diagnosis

A diagnosis is based on taking a clinical history and via a skin biopsy.  A Doctor will also check liver function, skin scrapings under a microscope (to check for scabies), and blood tests.

Prognosis

The prognosis is good with skin lesions healing in 3 to 4 months. The condition can leave behind a scar which is hyperpigmented (different skin color) or hypopigmented (loss of skin color).

Pityrosporum (Malassezia)

baby rashBaby Rash caused by Pityrosporum, a type of fungi.

Pityrosporum is caused by a type of fungi (Malassezia). It is seen in 20% of newborn infants during week 2 and 3.  It goes away by age 6 months to 1 year.

Symptoms

Inflamed skin pustules and papules that are commonly found on the cheeks, nose and forehead.

Treatment

Treatment may not be necessary. If treatment is needed, a Dermatologist will usually prescribe antibiotics (Amoxicillin), the skin cream Tazorotene (3 months) and salicylic acid (2 weeks)

Prickly Heat (Miliaria)

baby rashesBaby rashes caused by Prickly Heat Rash (Miliaria).

Prickly heat in babies (miliaria rubra) is common during hot weather.  It starts on the neck, and them appears on the shoulder where it can then move to the chest, face and ears.

Miliaria is a baby skin rash caused by a blockage of the sweat ducts. It is caused by overheating in babies that either live in a warm climate or that are dressed in clothes that are too restrictive and warming.

There are three types of Miliaria:

  • Miliaria Crystallina: 1mm to 2mm vesicles with no surround redness.
  • Miliraria rubra: most commonly known as infant heat rash
  • Miliaria pustulosa: form of heat rash with a more severe skin response

Symptoms

Symptoms of prickly heat include small pink pimples which are surrounded by pink skin blotches. The pimples can blister at the tip. It starts on the neck, and then spreads to the shoulders and chest.  It can even spread to the face and ears.

prickly heat baby skin rashPrickly heat tens to have no other symptoms, and is represented by clear small blisters. No treatment is needed. It usually appears during daylight and subsides at night.
Source: Borden Institute, US Army

Diagnosis

A diagnosis will be made by a Doctor based on the patient's clinical history and observation of the condition.

Treatment and Home Remedies

Prickly heat treatment involves keeping a baby cool such as keeping the baby in air conditioning and avoiding over dressing the infant.

Prickly heat home remedies include dusting corn starch on the pimples or use combine 1 teaspoon baking soda with 1 cup of water.  Apply with a cotton ball.  If this baby skin rash does not subside and begins to become more widespread, be sure to see a Doctor for treatment.

Psoriasis

Psoriasis in babies is an autoimmune disease caused by white blood cells that attack the skin. It can be seen in the scalp and diaper areas (may look like diaper dermatitis), and then spread to the trunk and extremities.  It is very rare in infants. 

Diaper psoriasis is referred to as infantile seborrheic dermatitis.  5% of infants that have seborrheic dermatitis develop psoriasis later in life.  The most common forms of psoriasis in infants are referred to as infantile psoriasis and juvenile pustular psoriasis.

Psoriasis can start in the first year of life, although pediatric psoriasis usually starts between age 2 and 10.  Skin lesions are circular or look like a ring as shown below in the first picture.

Infection, injury, certain medications, and hormonal activity can act as triggers for the condition.  In rare cases, the sun can act as a trigger, although the sun is helpful in the majority of cases.

Infant psoriasis symptoms include red, scaly areas in any location on the body, but usually on the scalp and diaper areas. 

baby skin rashThe infant psoriasis condition shown above was first misdiagnosed as seborrheic dermatitis. Baby skin rash can appear and disappear (remission) spontaneously.
Source: Principles of Pediatric Dermatology

Seborrheic dermatitis is characterized by lighter skin lesions, that are dull looking and covered by scales which are greasy.

baby skin rashInfant Seborrheic Dermatitis is often confused with psoriasis in babies. Seborrheic dermatitis is treated with a hydrocortisone ointment or mild shampoo as prescribed by your pediatrician. Source: Dr. Mahmoud Hijazy/Principles of Dermatology

Another form of psoriasis primarily seen in children 2 to 10,  has symptoms which appear as drops of red areas all over the body.  It is referred to as guttate psoriasis and appears on the limbs and trunk.  It comes on suddenly and can be triggered by an illness such as strep or tonsillitis, skin injury, some medications (antimalarials, beta blockers), and stress.

guttate psoriasis baby skin rashGuttate Psoriasis looks like "red drops" on the skin. It is several known triggers including infection (Strep), skin injury, medications (beta blockers), stress and skin injury.
Source: National Psoriasis Foundation

Rubbing or scratching the areas affected by psoriasis may result in the formation of new lesions, which is called the Koebner phenomenon. If there is a long history of psoriasis, the patient may have arthritis.

Treatment

Psoriasis treatment usually involves mild prescription topical corticosteroids, UV therapy, and vitamin D (D3) derivatives. Antihistamines are provided to help with the itch.  Antibiotics are prescribed if a strep infection is present. 

Medical supervision is crucial. 

Download this Guttate Psoriasis Fact Sheet from the National Psoriasis Foundation.

Baby Ringworm

Baby ringworm is caused by the contagious skin fungus dermatophytes. Also referred to a tinea faceii. It can happen anywhere on the body, but typically in early childhood on the face and head. Sometimes ringworm sores itch.

baby skin rashInfant Ringworm (Tinea Cruris, Candidiasis) Source: Dr. Mahmoud Hijazy/Principles of Dermatology

Symptoms

Ringworm symptoms present itself as red circles, scaled at edges. It’s highly contagious and usually shows up on the face and head, but can be found elsewhere and by sharing combs, brushes, hats etc. 

Treatment

Ringworm treatment is accomplished using topical anti-fungals are used for small lesions (griseofulvin). For larger ones and ringworm in the nails or hair, oral anti fungal agents such as itrconazole may be prescribed.

Scabies

scabies rash on babiesScabies Rash on Babies Legs and Feet

Scabies  is caused by a nasty little mite that burrows under your baby’s outer skin layer. It causes red, itchy lesions that appear as burrow lines. Babies get this from contact with another person who has scabies. Everyone in the house will need to be treated. This is a fairly serious skin disease in babies and medical help is a must.

Scabies Symptoms in Babies

Scabies symptoms include a red rash spread over the body in various locations, small white lesions in a zigzag or S-shaped pattern and severe itching.

Treatment

Scabies treatment involves a topical agent left on the skin overnight (see our article on How to Treat Scabies, which includes natural remedies as well). It may also involve antihistamines for the itching and topical steroid creams. This is a serious skin disease and you must have doctor supervision to ensure the topical agent is properly applied for a child. If you are pregnant, you must speak to your doctor about therapy.

Transient Neonatal Pustular Melanosis (TNPM)

baby skin rashesBaby skin rashes caused by Transient Neonatal Pustular Melanosis.

Transient neonatal pustular melanosis is a benign condition that creates no other symptoms. It is seen in darker skinned newborns and few infants that are caucasians. 

The skin problem is not associated with any underlying disease or serious illness.

Symptoms

Symptoms such as skin pimples (pustules and macules that are different than surrounding skin color) are typically seen on the:

  • chest
  • forehead
  • neck
  • buttocks
  • chin
  • soles
  • palms

Diagnosis

A definitive diagnosis is based on a clinical history.  If a Doctor is not certain, they can do a Wright stain test of a skin pimple sample.

Differential Diagnosis

A Doctor will need to differentiate a diagnosis of Transient Neonatal Pustular Melanosis from the following skin conditions:

  • Erythema toxicum neonatorum
  • Nonspecific viral exanthem
  • Congenital candidiasis
  • Acropustulosis of infancy

Treatment

Treatment may not be needed. To address symptoms a Doctor may prescribe a topical cream (Hydrocortisone 1%) and antibiotics for 1 week (Cephalexin 25mg).

Skin pimples should go away on their own in several days. Any skin areas with a different skin color may take 3 to 6 months to go away on their own.

Brochures




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References

Optiderma - Cradle Cap Treatment

MayoClinic.com

National Psoriasis Foundation

American Academy of Dermatology

Dr. Spock's Baby and Child Care, Benjamin Spock

Newborn skin: Part 1. Common rashes. O'Connor NR, McLaughlin MR, Ham P. Am Fam Physician. 2008 Jan 1;77(1):47-52. Review. 

Transient Benign Cutaneous Lesions in the Newborn. Neonatal Dermatology. Eichenfield LF, Frieden IJ, Esterly NB (eds). Neonatal Dermatology. 2nd edition. Elservier 2008. China. 85-9.