It’s not unusual for babies to have a variety of spots and rashes. Dr A Bolin looks at some of the common ones and what you can do to look after their delicate skin.

Baby rashes are very common, but why?  Over the first year of life (longer if your baby is born premature), your baby’s skin is maturing.  Dermatologists and researchers are able to measure and monitor the maturity of skin by seeing how hydrated it is, how much water evaporates from the surface (transepidermal water loss/TEWL), and by also checking pH values which are higher in infants. But at this stage your baby’s skin hasn’t properly developed it’s ability to act as a protective barrier.

As a protective barrier, skin helps regulate temperature and keeps out bacteria and infection. But as your baby’s skin is still developing, it’s easily irritated and susceptible to infection. As a result, it’s quite normal that rashes, spots and blemishes may occur.  Most will go away by themselves but if you’re concerned and unsure, the right decision is always to see your GP.  Also, if your baby seems unwell, has a fever, seems sleepy, and has a rash – do not wait, contact your healthcare provider immediately. (*See below for symptoms of meningitis.).

So what is the best way to protect my baby’s skin?

It’s easy to think that your baby might require the same kinds of lotions and potions you put on your skin – but this can often cause damage and irritate the skin – so unless you baby has a specific problem or you are advised by a medical professional, it’s often best to put absolutely nothing on them at all.

How should I bath my baby for the first month after birth?

• bath your baby with plain water in the first month at least – soaps, shampoos and shower gels can remove the skin’s protective natural oils so it’s best to avoid.
• Bath your baby three times per week (face and nappy area can be cleansed with cotton wool and water daily)
• Avoid skin lotions (even natural oils like olive oil have been shown to damage baby’s skin)
• Use alcohol-free, perfume-free wipes

My baby was born with a sticky white skin covering, what is it?

When your baby is born, there is a white creamy coating called the vernix caseosa (water, proteins, sebum lipids, water, antibacterial peptides) which protects and moisturises the skin.  It is important not to try and remove this, but to let it gradually absorb on its own.

If my baby is born preterm (premature) and has dry skin, should I use emollients?

If your baby is born preterm (premature), always discuss with your GP, paediatrician or dermatologist first before putting anything on their skin.  For example, some research has shown that putting ointments on the skin of preterm babies might increase the risk of skin infections.

If my baby was born past full-term (overdue) and their skin is dry or cracked, should I use creams?

• The vernix caseosa likely has been completely absorbed.
• Do not use creams or lotions.
• Once the dry skin has peeled and fallen off, new healthy skin will be underneath.

If I have a family history of asthma, eczema or seasonal allergies, or my child’s skin is dry and prone to eczema should I do anything special for my baby’s skin?

There is evidence that if your family has an atopic history (people in the family that have asthma, eczema and seasonal allergies), emollients (moisturisers) can improve the skin hydration, control water loss and help form a protective barrier which helps decrease inflammation.

But before you apply any creams or oils to your baby it’s always best to consult with your doctor. And even then it may be a case of trial and error to see which one suits your baby’s skin the best.  Ideally, perfume-free moisturisers are advised.  Options include creams, ointments, lotions, oils for bath and shower and soap substitutes. Emollient creams and ointments form a layer over the skin in order to prevent the water from evaporating.  Ingredients such as urea glycerol, propylene glycol and lactic acid attract and keep water in the skin.  Different medications can be added into the creams or ointments in order to decrease itch or infection.

If you are thinking of applying oils to your baby’s skin, it’s important to bear in mind that some oils may help but others may make your baby’s skin more likely to have skin rashes.  For example, one study demonstrated that sunflower oil helped hydrate and protect the skin whereas olive oil could promote development of rashes and worsen existing skin inflammation.  Discuss with your healthcare provider as to which is the best match for your baby.

Common rashes in the first year of life include:

Milia: Blocked oil glands.) Newborn babies often develop small white spots (blocked pores) which go away on their own

• No treatment necessary
• Usually resolve within a month

Miliaria (prickly heat): sweat glands that get blocked, causing raised small red bumps

• Will resolve on their own
• Avoid overheating
• No treatment necessary

Neonatal acne: nose, cheeks, forehead

• Do not pick or scratch
• Most of the time will resolve on their own
• Discuss with your healthcare provider (depending on age of baby) if there is a need for prescribed medical topical treatment

Seborrheic dermatitis (cradle cap): greasy thick whitish/yellow plaques on scalp – can also occur on eyebrows, ears, face, neck

• Put a small amount of emollient or baby oil on scaly scalp skin to soften before gently washing baby’s scalp and hair with baby shampoo
• soak the crusts overnight with white petroleum jelly or vegetable oil overnight and shampoo in the morning.

Often goes away on its own but if the problem persists, your GP may prescribe an anti-fungal treatment (such as clotrimazole 1% cream or miconazole 2% cream).

Eczema: red, inflamed, dry, cracked skin on scalp, face, body, skin folds (elbows/knees)

• Emollients are recommended for prevention and treatment
• Topical medications such as steroids (i.e. hydrocortisone) may be recommended by your GP to decrease skin inflammation. They may not cure the eczema, but will decrease the discomfort and symptoms
• Your GP or dermatologist might recommend antihistamines or calcineurin inhibitor creams (decrease the immune response and decrease inflammation).
• Other specialist recommendations include: bandages, phototherapy and oral medications

Urticaria (hives): raised, red, inflamed skin

• This occurs as an allergic response by your baby’s skin
• Due to histamine release
• Consider perfumes, food, pollen, etc. as possible triggers
• Speak with your healthcare provider to diagnose and for treatment (usually antihistamines)

Impetigo: yellow-crusted lesions, blisters on face, can be elsewhere on body

• Bacterial infection, often caused by streptococcus or staphylococcus infection
• Needs to be treated by a GP, usually with antibiotics (topical or oral, depending on how severe the infection is)

Nappy rash: a red and sometime raw looking rash that occurs in the warm, moist area covered by the nappy. It may feel hot to touch and there may be spots, blisters or pimples.

Causes include:

• Exposure to urine (pee) and faeces (poo) can irritate the skin, especially if nappies are left on for too long or the area isn’t well cleaned after each change
• The nappy rubbing on your baby’s skin
• Using soap, detergent or bubble bath that may irritate the skin
• Using alcohol-based baby wipes that can irritate and dry the skin
• A recent course of antibiotics may also be associated with nappy rash.

To treat it your doctor may advise:

• Changing nappies often
• Washing the area with water and mild hypoallergenic, fragrance-free soap and water, rinse well, gently pat dry (do not rub skin)
• Using fragrance-free and alcohol-free baby wipes
• Applying an emollient or barrier cream
• Bathing your baby every day without soap, bubble bath or lotions in the water,
• Cleaning the area gently but thoroughly, wiping from front to back, and drying the area gently
• Allowing your baby time with the nappy off so the area gets some air,
• Avoiding talcum powder as this may irritate the skin as well.

If I try all of these and my baby still has rashes, can I expect to see a specialist?

Your GP will assess your baby and if he/she does not respond to emollient and corticosteroid treatments, has more than 1-2 flares per month or if the skin condition interferes with school/sleep he may refer you to a dermatologist.  If your GP suspects an allergy is the cause, they will refer to an allergy specialist for testing and dietary advice.

*Note: It is important to know the signs of meningitis:

• a baby that becomes drowsy, floppy, hard to wake, or unresponsive,
• vomiting,
• fever,
• a purple rash or pale and blotchy skin
• becoming irritable and not wanting to be held
• unusual crying
• loss of appetite
• staring expression.

Never doubt your instinct as a parent: is you are concerns bring your baby to your nearest A&E to be assessed.