Skin Rashes in Newborns and Infants

When babies come out to welcome the world, they need to get used to life on the outside. This is doubly true for their skin. Over the next 4-6ish weeks of life, a baby’s skin can go through a lot of changes on the path to being ready for the outside elements.

Dry Skin Already?

The first change most families note is flaky dry-looking skin in the first few days to week of life. It usually starts in the crease areas of the wrists and ankles and spreads from there. Even though this looks like dry skin, it’s not. If you feel it, the skin underneath is still baby soft and not dry or unhealthy feeling. So don’t feel like you need to put on lotion or moisturizers to get rid of this top layer of skin that is made to be in amniotic fluid. No matter what you do, it will slough off like lizard skin over the first few weeks. 

Erythema Toxicum

This is a horribly scary name for a very normal (not scary) baby skin rash. This rash usually appears pretty soon after baby is born and will be these red splotches with a raised white dot in the middle. It will be in one place one day and somewhere else the next. The skin is basically testing out its defense mechanisms on various skin parts for the first few weeks of life.  Nothing to do or treat here. 

Nevus Simplex

Also known as stork bites or angel kisses, these splotches of red skin are very normal on most parts of baby’s body. We most commonly see them on the back of the neck, the eyelids, and the area between the eyes on the nose/forehead. These represent extra blood vessel growth during the last part of development, and we see it more in certain areas because some areas of skin are thinner than others. They will look more red if baby is warm or mad/crying. As the skin gets thicker over the first year of life, we won’t see these vascular beds anymore.

Capillary Hemangiomas

Sometimes called strawberry hemangiomas or cherry hemangiomas due to their circular red sticking-out appearance, these are a common type of birthmark in kids. They are usually the size of a dime or smaller. These birthmarks will grow with baby’s skin for the first 6 months of life or so and then start to regress on their own. Sometimes we will talk to the dermatologist and treat these with either a topical or oral form of the medicine propranolol. We usually treat ones that look like they want to bleed, ulcerate, or scab over. Or if they are very large in prominent places. Or if they will inhibit the development of the baby such as one near the mouth that can impair feeding. If there is a spot like this near an airway or on the throat, it will also get investigated by an ear, nose, and throat (ENT) doctor to make sure there is no actual involvement of the airway inside baby.

Congenital Dermal Melanocytosis

Formerly and inappropriately known as “Mongolian spots” these are large slate grey to bluish birthmarks on kids. These are most often on the lower back but can also be found on the extremities. Over the first few years, they will disappear on their own.

Neonatal Acne

Just like teenagers, babies can get hormonally derived acne, but at this age, the hormones are the ones from mom that baby was exposed to in utero, now leaving their bodies. This hormone shift can yield baby zits all over but usually on the face, back, and chest. If a baby has this type of rash, it usually improves by week 6 of life.  There is nothing you need to do for this rash to make it go away, but if you want to put Aquaphor on areas that look more irritated to help protect that skin, that is okay. 

Cradle Cap/Seborrheic Dermatitis

Also partially hormonally derived, this rash looks almost like fish scales and small flakes on the head, behind the ears, and around the eyebrows. It can also appear in other skin fold areas of the body and the diaper area. I have some families who come to me frustrated that even after using the fancy cradle-cap shampoo and painstakingly going through with a special comb to get rid of these flakes on the scalp, it keeps coming back. Yup, no matter what you do the flakes will keep coming back until the scalp and hair follicles mature, which can be weeks to months (or years in some kiddos). But if you have some cool family photo session coming up or a special occasion where you want baby to look pristine, applying an oil like mineral oil, coconut oil, or a fancy cradle-cap lotion (also oil) to the flakes and brushing them away with a cool cradle-cap brush (like the one from Safety 1st) will make them go away for 24-48 hours. But again, it will come back if those skin areas are not ready to be fully mature yet. 

Prickly Heat

Heat rashes occur in babies all the time. As parents, we often overdress them, or when they are feeding, being close to their parent is just a warm environment. The skin will naturally try to cool itself off by sweating. Unfortunately, it takes a bit of time for baby’s skin to learn how to sweat correctly, and the body will sometimes deposit sweat underneath the top layer of skin. So we often see this red zit-looking rash on areas that get warm on baby. Once the baby cools down or a cool compress is placed briefly on the areas, it will go away.