Neonatal Rashes

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					     Indiana University Department of Emergency Medicine                          Spring 2008

               Neonatal Rashes
                                       A Parent’s Guide

Don’t Fret! You’re Child
Has Been Diagnosed With                                                Common
                                                                      Rashes of the
a Common Neonatal Rash.                                                Newborn
                                                                       Sebaceous Gland
        Rashes in the newborn period are exceedingly common            Hyperplasia
and range from life-threatening to nothing more than a nuisance.
You’re child was diagnosed with ____________________ today.            Milia
Your child’s rash does not appear to be serious at this point.
Listed below, you will find specific instructions as to how best       Miliaria
care for your child’s rash. Additionally, you will find several on-
line resources listed for your convenience, as well as specific        Erythema Toxicum
return instructions should your baby’s behavior change or should
                                                                       Pustular Melanosis
the rash change. Most importantly, this time in your life and
your baby’s life is ever so precious and we want you to fully          Neonatal Acne
cherish this blessing. Please read over the handout we have
provided you and ask as many questions as you like. For further        Seborrheic Dermatitis
help, you can call your pediatrician, review our online resources,
or return to the emergency department.                                 Hemangioma

                                                                       Diaper Rash

                           Return to the ED immediately for decreased
                         feeding, decreased wet diapers, fever, vomiting,
                         lethargy, worsening appearance of rash, or any
                                          other concern.
 Indiana University Department of Emergency Medicine             Spring 2008

Common Neonatal Rashes
   Sebaceous Gland Hyperplasia
   This is a physiologic process caused by maternal
   androgens (hormones), presenting as tiny yellow to flesh-
   colored papules on the nose, cheeks, and upper lips. No
   treatment is necessary as this resolves spontaneously
   within the first few weeks of life.

   Small cysts resulting from the retention of keratin within
   the dermis. They appear as tiny 1-2mm pearly white or
   yellow papules on the cheeks, nose, chin, and forehead.
   No treatment is required as this rash usually disappears by
   3 to 4 weeks of life.

   This rash presents as small, discrete erythematous (red)
   papules or vesicles. One variety of this rash, known as
   milaria rubra is more commonly called “prickly heat.”
   As the name implies, this rash occurs when sweat glands
   are too immature to function properly and become
   blocked. Treatment is directed toward avoidance of
   excessive heat and humidity, and the child should wear
   light-weight cotton clothing, have cool baths, and stay in
   air conditioned locations when possible.

   Erythema Toxicum
   This rash initially presents as erythematous (red) lesions
   that often look blotchy at first, then develop firm, tiny
   white or yellow papules. This rash can be anywhere on
   the body, but usually does not involve the palms and
   soles. This is most commonly seen within the first 3 to 4
   days of life. As this rash disappears spontaneously by 2
   weeks of age, no treatment is necessary.

Indiana University Department of Emergency Medicine        Spring 2008

  Pustular Melanosis
  Also known as Transient Neonatal Pustular
  Melanosis, this rash presents as small pustular
  lesions that rupture easily, then evolve into darker,
  hyperpigmented areas. This rash occurs more often
  in kids with black skin. The distribution of this rash
  is most often under the chin, on the forehead, neck,
  lower back, and shins. The rash usually resolves
  spontaneously within several days and requires no

  Neonatal Acne
  This rash often times resembles the common form of
  acne seen in adults. It is likely caused by hormonal
  stimulation of immature sweat glands. If it is a mild
  case, the only therapy necessary is daily cleansing
  with soap and water. Baby oils and lotions should
  be avoided. In more severe cases, your doctor may
  prescribe to you a topical treatment such as 2.5%
  benzoyl peroxide or a topical antibiotic such as
  erythromycin or clindamycin. This rash may take
  several months to completely resolve.

  Seborrheic Dermatitis
  Also known as “cradle cap,” this rash appears as a
  greasy, scaly, red rash that is usually moist and may
  be weeping. As the name implies, it is often found
  on a baby’s scalp, but can also be on the face, ears,
  trunk, and in other areas where there is a high
  density of sweat glands. It appears most commonly
  between the second and tenth weeks of life.
  Treatment involves frequent shampooing with a
  gentle no-tears baby shampoo. An anti-seborrheic
  shampoo, such as ketoconazole shampoo, Selsun,
  Head and Shoulders, or T-Gel, may be necessary but
  can be overly drying or irritating to your baby’s skin
  and eyes.

Indiana University Department of Emergency Medicine                    Spring 2008

   Diaper Rash
   This is the most common rash in childhood. There are 3 main
   varieties: Chafing dermatitis, irritant contact dermatitis, and
   candidiasis. Chafing is the most common and presents in areas
   where there is friction. It appears mildly red and tends to wax
   and wane quickly. Treatment for this form is frequent diaper
   changes and good diaper hygiene. Contact dermatitis, as the
   name implies, is due to excessive skin contact with stool, urine,
   moisture, irritant chemicals, soaps, detergents, and topical
   preparations. Treatment is aimed at avoidance of the particular
   exposure, frequent diaper changes, and good hygiene. Lastly,
   diaper rash can be caused by yeast, in which case a topical anti-
   fungal agent will be prescribed by your doctor.

Indiana University Department of Emergency Medicine   Spring 2008

Return Immediately For
Any of the Following:
Decreased feeding
Decreased wet diapers
Worsening appearance of rash

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