Ask a derm: What’s up with my newborn’s skin?

There's a lot going on with newborn skin, and it can be confusing. Let's lay it all out for you.

If you entered into parenthood blithely thinking that newborn skin was going to be all chubby wrists and velvety little cheeks, well—think again. (You will get to that, though. Never fear.) Those early days, weeks, and months can seem like an ever-more-confounding series of newborn skin issues: first there are the stork bites, then the peeling, then the acne, then the rashes…the list is endless. To clear everything up, we asked Mona A. Gohara, MD, dermatologist and Associate Clinical Professor at Yale School of Medicine’s Department of Dermatology, to walk us through the most common newborn skin conditions—and what parents can do about them.

1. Dry or peeling skin

The look: 
“As the name of the condition suggests, the skin looks flaky, dry, and can peel off with just the slightest touch. The hands and feet are usually the most involved, but any part of the body can be affected.”

When newborns get it:
“This can begin any time within the first week of life.”

Why newborns get it:
“First and foremost, don’t worry. This is completely normal and happens to most newborns. When your little one makes their debut into the world they’re well-moisturized, courtesy of mama and nature. A mix of amniotic fluid, blood, and vernix (we’ll get to what that is in a second) keeps their skin hydrated in utero. Vernix caseosa, or vernix, is a waxy coating that protects the skin during fetal development. After your baby is born and cleaned, however, their natural sources of moisture are washed away, and the skin needs to adjust to its new world. The process of developing a stronger moisture barrier takes time, and the skin will almost certainly peel during the transition. Think of it in an ‘out with the old, in with the new’ kind of routine.”

How to treat: 
“Gentleness is key here! At bathtime make sure that the water is lukewarm, use a gentle cleanser, remember to pat and not rub the skin when drying, and use a soft cotton towel. Apply a moisturizer within minutes of bathing to lock in moisture. Also, avoid temperature fluctuations, harsh detergents, and wool clothes.”

How long it lasts:
“This whole process of skin peeling generally lasts anywhere from one to three weeks. Remember to not stress—it’s a natural, physiologic process."

2. Jaundice 


The look:
“Infantile jaundice is characterized by yellow discoloration of the skin and eyes.”

When newborns get it:
“Jaundice usually occurs between the second and fourth postpartum day.”

Why newborns get it:
“In general, this occurs because the baby’s liver isn’t quite capable yet of getting rid of excess bilirubin in the blood. Bilirubin is a yellow pigment that lives in red blood cells. Although it can be alarming, jaundice is common, especially in babies that are born before 38 weeks. A doctor will examine your infant to make sure that there are no other factors or conditions involved in causing jaundice.”

How to treat:
“Your doctor will determine if there’s a need for intervention and treatment. Often, time is the best medicine.  She may also recommend phototherapy, whereby light is used to help the bilirubin dissolve more easily through a process called photooxidation. Each circumstance should be evaluated and treated accordingly by a medical provider.”

How long it lasts:
“Jaundice usually lasts two to three weeks in newborns, although there’s always some variability.”

 

 

“Those early days, weeks, and months can seem like an ever-more-confounding series of newborn skin issues: first there are the stork bites, then the peeling, then the acne, then the rashes…the list is endless."

3. Stork bites, port-wine stain, or nevus flammeus

The look:
“These are flat pink or red marks with irregular borders. Most commonly these birthmarks are seen at the hairline on the back of the neck. Similar variants can be seen on the forehead (‘angel kiss’) or other parts of the face. They may get darker or more prominent with age, crying, or changes in temperature. Stork bites last into adulthood if untreated and can become more textured with time. If other physical exam findings or systemic symptoms occur, further evaluation may be warranted.”
When newborns get it:
“These lesions are present at birth.”

Why newborns get it:
“Although the exact reason stork bites come about hasn’t been fully clarified, we know one thing: it has nothing to do with what mothers have or haven’t done during conception or pregnancy, and you cannot prevent them. These birthmarks occur when the blood vessels in the skin dilate and get bigger. This change is caused by a genetic mutation, the cause of which is unclear.”

How to treat it:
“No treatment is necessary—though if it’s desired for cosmetic purposes, laser treatment can be explored.”

How long it lasts:
“Unless treated, stork bites will last for a lifetime. I see them routinely on my adult patients when examining their scalps.”
4. Baby acne or neonatal acne

The look:
“Baby acne is characterized by small red bumps or pustules on the face. Most commonly they occur on the cheeks, nose and forehead. Don’t panic if you see breakouts on the scalp, back, and chest as well. Some may also think that milia—another very common newborn skin condition that disappears on its own—is baby acne, when in fact they are tiny pearl-like cysts filled with the skin protein keratin.”

When newborns get it:
“Baby acne usually occurs between two to four weeks of age, but sometimes it’s present at birth.”

Why newborns get it:
“Although there’s no confirmed cause of baby acne, some think that it results from exposure to maternal hormones either during pregnancy or breastfeeding. Acne occurring after 6 weeks is called infantile acne. Although it may appear similar, timing and maybe cause is different. In either case, it’s important to see a board-certified pediatric dermatologist who can guide you further in terms of treatment.”

How to treat it:
“Most importantly, don’t worry. Your dermatologist will likely advise you to use a gentle cleanser. It’s a good idea to avoid using acne treatments unless your doctors recommend otherwise. Also steer clear of oily skincare products and scrubbing. Often no treatment is necessary, and within a few weeks your baby’s complexion will naturally clear.”

How long it lasts:
“Baby acne may last a month or more, but don’t panic—or pop!”
5. Infantile Hemangioma 

The look:
“This benign birthmark looks like a red or purple spongy bump on the skin. It has an appearance similar to a strawberry and can occur anywhere on the body. If it’s large, on the midline spine, or is in an area where breathing, vision, or eating can be disrupted, immediate attention is warranted.”

When newborns get it:
“Hemangiomas generally are apparent at birth, or within the first several weeks of life.”
Why newborns get it:
“Hemangiomas are a benign proliferation of blood vessels. Although the exact cause is not known, some science has suggested that they are derived from placental proteins.”

How to treat it:
“Hemangiomas should be evaluated by a doctor. If they are large or in a critical area, treatment may include lasers, or topical or intravenous medications such as beta blockers. These growths usually spontaneously resolve completely within the first decade of life. “

How long it lasts:
“These growths usually spontaneously resolve completely within the first decade of life.” 
6. Diaper rash

The look:
“Ouch, poor babies—this one can be a doozy! Impossible to miss, this is characterized by a red, raw, and tender bottom. You may notice crying with diaper changes or sitting down, too. Luckily, there are ways to get through this quickly.” 
When newborns get it:
“There’s no rhyme or reason to the timing here. Any time there is an irritation (or sometimes an infection), diaper rash can occur.”
Why newborns get it:
“Diaper rash is most commonly due to moisture and irritation from urine or feces. Infection or allergy to diaper creams could also be culprits. Again, seeking the help of a board-certified pediatric dermatologist is imperative, as she can help to distinguish cause and prescribe appropriate treatment.”
How to treat it:
“One of the most important tips for treating diaper rash is frequent diaper changes! Even if the diaper is barely wet, be alert and ready to put on a fresh one, as this reduces the moisture and contact time with potential irritants. Also, make sure to use a gentle cleanser with baths, and a diaper cream with changes. Be liberal with the amount you apply. Use moisturizers that help with barrier protection when the skin isn’t inflamed to prevent future rashes. Contacting a board-certified pediatric dermatologist should be top of mind, but this is particularly important if the baby is difficult to console, develops fever, blisters, pus, or a rash that persists despite treatment.”
How long it lasts:
“The quicker you get it evaluated, the quicker treatment and resolution can begin!”

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