Infant Series: Skin
Newborn skin can develop a diffuse peeling in the first two weeks. This is the outer skin layer that sloughs off as the new skin grows in. This does need any specific treatment as it will resolve with time, usually by 2-3 weeks. For moisturizer for the skin, we recommend Aquaphor, Vaseline or Johnson and Johnson’s hypoallergenic lavender lotion.
Dry skin occurring in patches and often with an itchy, thickened red component is called eczema. This is seen later in infancy usually first seen in the cheeks and then later the extremities and in the skin folds in the elbow and behind the knees. It is extremely common and is more common with babies who have other allergies (history of wheezing or allergic rhinitis) or with parents with allergies. The cornerstone of treatment is with moisturizers (Aquaphor or Vaseline) often 3-4 times per day. Over the counter hydrocortisone for up to a week can be used on the body for flare ups. Another natural moisturizer we have used is called Emily moisturizer and can be found at emilyskinsoothers.com. CeraVe cream or lotion is another excellent moisturizer which can be purchased at Rite-Aid pharmacies or through the internet at www.drugstore.com .
Red bumps on the face and neck (papules)
Babies have very sensitive skin and often react to anything from heat to any contact with small red bumps of the face and neck. Some refer to this as the common “heat rash”. This usually is intermittent and mild in nature and requires no treatment other than Aquaphor or Vaseline to the area if it is dry to act as a barrier. Lesions which do not blanch (turn white after pressing on them with your finger) or blisters are not normal and need evaluation.
Also known as salmon patches, angel’s kisses or nevus simplex, these birthmarks are small blood vessels visible through the skin and are present in 30-50% of normal newborns. They are most commonly found on the eyelids, nose, in between the eyebrows and on the nape of the neck. On the face these uniformly resolved with time whereas the patches on the nape of the neck always fade but sometimes persists into adulthood. (Lots of parents have this and do not realize it).
This is a different type of birthmark with a raised, red bumpy appearance. It is typically not seen or very small at birth and grows larger up until around 9 months, after which time it starts to shrink in size and usually has disappeared by 5-9 years old.
Mongolian spots look like dark bruises usually on the sacrum and resolve on their own usually by 3-5 years of age.
Neonatal acne is marked by scattered fluid filled spots and red break outs on the face neck usually appearing by several weeks of age and lasting until 2-3 months of age. NO treatment is required, and the natural history is for complete resolution. This is a response to the high estrogen levels inside the womb.
There are two diapers of diaper rashes: fungal rash and regular diaper rash. Fungal rash is a beefy red rash found in the creases of the inguinal and buttock region from excess moisture. It is easily treated with Lotrimin cream over the counter. Regular diaper rash is on the mounds of the buttock usually around the anus and is due to the sensitive skin exposed to stool and urine in the diaper. These are treated with avoiding stringent wipes (just rinse and pat dry for diaper changes) and any of the zinc oxide emollient creams (Desitin, A +D ointment, Boudros butt paste, Aquaphor, balmex). We also have had success with calmoseptine ointment (available over the counter but often needs to be ordered by the pharmacy). The best way to treat a diaper rash is to prevent it by using prophylactic Aquaphor or Vaseline if your baby has soiled diapers more than 3-5 times per day.
Umbilical Hernias are quite common and often look dangerous than they are. No matter how big it seems, as long as the hernia is soft and easily reducible, these are safe, and the majority do resolve on the own. Usually, umbilical hernia will resolved by 1 year and persistent hernias after 18 months is my experience often require surgery.
Bumps behind the ear
Behind the ear is a lymph node chain called the posterior auricular chain. Often small pea sized lumps are felt behind the ear which are non-painful and freely mobile. These are more common in babies with any scalp dermatitis such as cradle cap as the lymph nodes can swell as bacteria found on the scalp is destroyed and broken down in the lymph system. As long as the lymph node is getting bigger, or red or painful (signs of infection), we recommend following it conservatively with time. There is also a normal prominence of the bone in this area. If a lump feels “fixed to the bone”, asymmetric, or is growing in size, this needs evaluation.
Babies (boys or girls) can sometimes develop breast buds as infants from exposure to high levels of estrogen in utero. This causes small non painful nodular swelling behind the nipple. These uniformly resolve by 3-6 months of age.
Sunscreen is not FDA approved for children under 6 months of age. However, in San Diego, we have seen many babies with 1st degree sun burns from sun exposure (even when parents thought they were covered with a hat or umbrella). Avoid direct sun exposure in the first 6 months and if sun exposure cannot be avoided, we do think the benefits of sunscreen outweigh the risks. It is ok with us to use sunscreen under 6 months.