DRY SKIN ( ECZEMA, ATOPIC DERMATITIS): Please click on this link for further information.
ERYTHEMA TOXICUM: Erythema Toxicum is present in as much as 50% of newborns and is not harmful. The rash looks bright, splotchy red in patches that may join, has pinpoint sized yellow-white pustules, is mainly on the face and torso and is never on the palms of the hands or soles of the feet. The rash develops around 2 days of age and usually is gone in a week. Do not break the pustules as you may cause an infection. No special care is necessary for the rash and no treatment is necessary or effective. If your baby has this rash and is ill, then call me immediately.
HEAT RASH: Many babies will have a fine, slightly raised, light to medium red rash. The size of the spots is about 1-2 mm or 1/32 - 1/16th of an inch. The rash may be anywhere, but is usually on the torso, neck or abdomen. When a baby is kept too warm, he or she will sweat, but because his or her sweat glands are still immature, the sweat glands will form small raised red bumps. This is a heat rash. Heat rash is not harmful, but tells you that your baby is probably too warm. The rash does not need treatment, but can be prevented by more appropriate clothing. Try to dress your baby similar to what you are wearing and don't overdress him or her just because its cold outside. Dress your baby for inside temperature and wrap him or her in blankets when you take him or her outside. If your baby has the above rash and is well, then follow the above instructions. If your baby has the above rash and is ill, then please call me immediately.
INSECT BITES: This can be broken down into prevention, treatment and complications. PREVENTION: Insect bites are impossible to completely prevent, but try by avoiding the insects by staying inside or using nets or protective clothing outside. Insect repellant (especially DEET) is dangerous when used below 1 year of age. Skin so soft by Avon is acceptable, but will not protect you against the insects that spread encephalitis (the new one is being tested for this). TREATMENT: Itching and inflammation can be reduced with topical over the counter hydrocortisone or Benedryl and or oral Benedryl (see medicine section). If you can apply meat tenderizer (Accent) to the bite within a few minutes ,then the meat tenderizer will break down some of the insect protein that causes the swelling. After the first few minutes, meat tenderizers are ineffective. COMPLICATIONS: The most frequent complication is local infection from the break in the skin itself or the dirty finger that scratches the bite. Treat and / or prevent this by applying an over the counter triple antibiotic cream (Neosporin). If the skin appears very red, warm to the touch, is swollen or rapidly worsening, then call the doctor immediately. The most worrisome and rarest complication is encephalitis, which is a brain swelling due to a viral infection. This mainly occurs in the summer from July 1st and extends in to September occasionally. The symptoms are headache, vomiting, eye pain from light exposure and high fevers. As you can see the symptoms are difficult to interpret in a infant and you simply may only see an irritable child that is inconsolable, wont eat and has a high fever. If you see any of these signs, then call a doctor immediately.
JAUNDICE ( YELLOW SKIN ): Jaundice is a yellow color to the skin due to a normal breakdown product of the blood. The liver gets rid of that breakdown product for us. The mother's liver was doing this until birth and the baby's liver takes a few days to adjust to getting rid of this product by itself. Almost all newborn babies will have jaundice to some degree. Before 2005, we relied on parents to bring their baby into the office if they noticed jaundice. National experts realized that this method had significant problems. Its hard for some parents eyes to detect jaundice and you can't tell how bad it is by vision alone. Starting in 2005, the new national standard of care is to check the baby with a painless electronic device before discharge from the hospital. Depending on the level, I will see your baby in the office 1-3 days after discharge to check the level again. This visit is also a nice time to go over any questions you may have after being overwhelmed with information after delivery, and settling into life with your new baby at home. If the jaundice level is high, then the first line of treatment is special bright lights (phototherapy) that help your baby get rid of the breakdown product. A few days of phototherapy is usually all that is necessary and they may be performed outside of the hospital in the form of a fiber optic blanket in most cases. Our office does have the special electronic device to measure jaundice painlessly and instantly (Bilichek).
MONGOLIAN SPOT: This is a blue black spot on the buttocks area that resembles a bruise.
MOTTLING: Skin mottling is usually your babies response to being cold. The skin will have a purple-red lacy appearance with a pale white skin in between the red lines. If you child is well, then you simply need to warm him or her up to make the mottling go away. If your child is mottled and is ill, then wrap him or her up in a blanket and call me immediately.
PEELING: Most newborn babies will have some peeling of their skin during the first week or so. This is not due to dryness, but is rather a normal response of the skin to being born. A moisturizer or lotion is not necessary, but may be used sparingly if labeled safe for infants. Apply any lotions sparingly to the face as there is a controversy over whether the chemicals in the lotions are absorbed from the face.
Copyright 2006, Joe Matusic, MD, FAAP, AME