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Benign Skin Rashes in Infants

The Majority of Cutaneous Eruptions in Newborns are Harmless

Mar 30, 2009 Stephen Allen Christensen

During the first few weeks of life, a baby's skin can exhibit a variety of rashes that cause concern for parents. Most of these phenomena are benign and transient.

At birth, many of an infant’s organs and systems are immature, and their development may not be complete for weeks or even months. It is the relative immaturity of these structures that often contributes to the development of skin conditions that aren’t normally seen in older children and adults.

While some rashes indicate the presence of underlying disease, most are benign and do not require treatment.

Some "rashes" result from normal newborn vascular physiology—that is, they appear when blood vessels respond inappropriately to environmental stimuli.

Incomplete development of various skin structures (e.g., sweat glands or sebaceous glands), a normal response to maternal hormones, or newborn immune mechanisms may be responsible for other rashes.

Skin Changes Due to Vascular Physiology

Cutis marmorata: A reticular mottling of the skin that symmetrically involves the trunk, arms, and legs. This discoloration—a response to cold that generally resolves when the skin is re-warmed—is flat and resembles a lacework of reddened or bluish areas overlying a blanched background. Some children may retain this condition for the first few years of life.
Harlequin color change: Babies who have been placed on their sides may develop this harmless condition; it usually appears in the first week of life and may last for three or four weeks. The downward side of the body becomes reddened while the upward side becomes relatively pale. This color change may develop suddenly and persist for a half hour or so; it usually resolves with increased movement or crying. When brain centers that control blood vessel dilation mature, the condition disappears.

Other Harmless Rashes of Infants

Erythema toxicum neonatorum: Reddened spots and “pimples” on the face, trunk, and proximal extremities that develop into pustules (whiteheads). May be present at birth, but more often appears during the first week of life. Affects up to 70% of infants; lasts up to several weeks.
Transient neonatal pustular melanosis: Raised blisters and pustules that rupture easily, leaving a small, pigmented spot. May affect entire body, including palms and soles. Occurs in up to 5% of black infants, and less than 1% of white newborns. Usually fades over a month or so.
Acne neonatorum: Resembles adolescent acne, occurring on the forehead, nose and cheeks (may involve the chest or other areas). Occurs in about 20% of newborns. Usually resolves within a month or two without scarring.
Milia: Characterized by 1-2 mm white or yellow pimples on the face, upper trunk, extremities, penis, or mucous membranes. Occurs in 50% of infants. Disappears within two to three months.
Miliaria: Two common and distinct forms. Miliaria crystallina consists of small blisters on the head, neck, or trunk. Blisters do not have red bases. Each blister resolves within hours to days. Miliaria rubra (heat rash) occurs on covered skin. Consists of small, reddened pimples and blisters. Avoidance of overheating helps prevent this condition.
Seborrheic dermatitis (“Cradle Cap”): Extremely common; consists of redness and oily scales on the head, face, neck and ears. Usually resolves within several months. Scales can be removed with a soft brush after shampooing hair. Vegetable oil or petrolatum may help to soften scale prior to washing. Severe cases can be addressed with tar-containing shampoos, antifungals, or mild topical steroids.

Although most infants’ rashes do not indicate serious illness and do not require treatment, any newborn who has a rash or discoloration and who appears to be sick should be promptly seen by a physician.

(From O’Connor N and McLaughlin M. Newborn skin: part I. Common rashes. Am Fam Phys 2008;77(1):47-52)

The copyright of the article Benign Skin Rashes in Infants in General Medicine is owned by Stephen Allen Christensen. Permission to republish Benign Skin Rashes in Infants in print or online must be granted by the author in writing.