July 24, 2008
Newborn Rashes Common, Mostly Harmless
By Dr. Helen Minciotti
Mom and dad showed up on time for their newborn's first outpatient exam. That was already quite an accomplishment, considering the packing and infant bundling needed before venturing out in the frigid winter air.
The 4-day-old was already gaining weight and looking great, but his parents had some concerns about his skin.
The little guy did have a funny-looking rash, but one that I've seen on many other newborns. Clusters of raised yellow lesions were surrounded by pink skin, and were very visible on his chest and abdomen.
I assured the parents that although the rash had the lethal sounding medical name of erythema toxicum, these clusters were part of a well-known and perfectly benign baby rash. Erythema toxicum can be seen in up to half of all newborns. It shows up within the first few days, comes and goes during the early newborn period, and spontaneously disappears by two weeks of life.
Another common and equally harmless skin condition is neonatal milia. Milia, often confused with acne, are actually tiny white cysts most often seen on a newborn's nose. They're gone after a few weeks, and once again, no treatment is needed.
Darker skinned babies can be born with Mongolian spots - areas of flat bluish or blue-gray discoloration. These birthmarks are most often seen on the back and buttocks, but can be found over other parts of the normal newborn body. Also known as congenital dermal melanocytosis, these spots tend to fade with age and typically resolve by the teen years.
Mongolian spots are benign and insignificant from a health point of view. I still try to point these areas out to parents and jot a note in the baby's medical record, since the spots most closely resemble bruises and are often erroneously identified as such by well-meaning friends and relatives.
Other neonatal skin lesions sometimes blamed on trauma are the commonly occurring and colorfully named salmon patches or stork bites. These flat, pink patches are found in approximately one- third of normal newborns. They are vascular lesions, usually of the upper eyelids, but also seen elsewhere on the face as well as the back of the neck.
Salmon patches are more visible in babies when they cry or are warm. While many of these facial lesions are gone by the toddler months, those on the back of the neck tend to persist. The neck patches are not a significant cosmetic issue as they are out of sight and usually hidden by hair.
It's generally a good idea for new parents to become familiar with these and other common newborn skin conditions, but don't feel like you need to diagnose your own child. While most of the skin lesions you'll see in your child's first weeks are transient and benign, some newborns can present with more serious look-alike rashes.
Your pediatrician will examine your new baby several times during the neonatal period. If you've seen anything you can't identify or aren't comfortable with, make sure to discuss your concerns during these visits.
- Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.
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