Common Skin Problems in Babies

It is very common to hear mothers complain of rashes on their babies, that it is probably safe to assume that anything red or elevated found on their babies’ skin is referred to as a “rash.” It is thus necessary to differentiate those that are potentially dangerous or life-threatening and those that are milder and treatable on an out-patient basis. This article discusses some of the more common ones.

In the immediate newborn period there are transient skin diseases, problems that appear at birth and are resolved in 30 days. Milia are pinpoint papules (butlig na walang tubig) on the forehead, cheeks and nose, caused by retention of keratin within the baby’s dermis. Erythema toxicum is characterized by blotchy red macules (flat color change on the skin less than 1 cm) with a central vehicle or pustule, usually on the chest, back, face, and arms. Acne in the newborn may also manifest this way.

Mottling is common in babies, a blotchy bluish erythema that appears when a baby feels cold and improves upon rewarming. It is not uncommon to find crusting on the scalps of babies (cradle cap), a finding that may well be present until about three months of age, characteristic of seborrheic dermatitis. These clinical entities are amenable to topical and supportive treatment, and sometimes, none at all.

Skin lesions or changes may be a sign of infection or sepsis in the newborn. Vesicles or blisters (butlig na may tubig), pustules, jaundice (naninilaw), petechiae and/or pallor accompanied by lethargy, irritability and poor feeding give a clue to bacteria or viral infection and hence the baby must be immediately brought for evaluation.

In older babies, mothers often complain of pink-red patches, with or without scaling, on the cheeks. Sometimes the trunk and extremities are also affected, and the baby looks very uncomfortable, owing to intense itch. Atopic dermatitis, more common in families with a history of asthma or eczema, presents this way. There may be other accompanying skin signs, like blotchy white patches on the face and arms (pityriasis alba) and very dry skin. Patients are given a mild skin cleanser, low-to-mid potent topical steroids and moisturizing agents. More often than not the condition resolves without complication, but at times bacterial infection ensues, brought about by frequent scratching and manipulation of the skin. Oral antibiotics are then necessary. As the condition is recurrent, avoidance of possible triggers (e.g. food/ milk intolerance) is very helpful.

Another common problem is intertrigo. Seen on body folds, this manifests as red patches often found in the groin and armpits, and in chubbier babies, the neck fold. The presence of sweat in this area, plus the constant friction of movement, causes the problem. It is often expected to find consequent fungal infection, as these factors enhance its possibility. The appearance of small red papules around a bright red, beefy, glistening moist plaque in the groin, axilla and neck suggests candidal intertrigo, a yeast infection. Topical antifungals provide definitive therapy, but foremost is the prevention of precipitating factors.

“Bungang-araw,” (miliara rubra) is a frequent complaint especially during the summer months. These are very pruritic, almost pinpoint pink papulovesicles on the back, erupting when the patient is placed constantly in a hot, humid environment. Cooling is the most important preventive step, and it is suggested that affected individuals take quick showers with mild cleansers.

In summary, these are the most important points:

• Keep babies in cool, comfortable environments, dress them in light and light-colored clothes.
• Avoid soaking in wet diapers or liners. Keep them clean and fresh all the time.
• Observe for any changes in the baby’s overall disposition: irritability, poor feeding, etc.
• Do not ignore skin problems. Moreover, do not self-medicate, either with topical creams and ointments, or herbal extracts and coconut oil. The application of menthol, salicylic acid, and sulfur in oil and many others can cause irritation and burning of the baby’s skin.
• Seek medical care. Worrying (on the parent’s part) and complications (on the baby’s) can be avoided if prompt and accurate medical diagnosis is given and treatment is instituted.