Rash - child under 2 years
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Baby rash; Diaper rash; Miliaria; Prickly heat
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A rash is a change in the color or texture of the skin. A skin rash can be flat, bumpy, scaly, red, skin-colored, or slightly lighter or darker than skin color.
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Most bumps and blotches on a newborn baby are harmless and clear up by themselves.
By far the most common skin problem in infants is diaper rash. Diaper rash is an irritation of the skin caused by dampness, urine, or feces. Most babies who wear diapers will have some type of diaper rash.
However, there are other skin disorders that can cause rashes. These are usually not serious unless accompanied by other symptoms.
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- Diaper rash (rash in the diaper area) is a skin irritation caused by prolonged dampness and the interaction of urine and feces with the skin.
- Yeast diaper rash is caused by a type of yeast called candida, which also causes thrush in the mouth. The rash looks different from a regular diaper rash. It is very red, and there are usually small red bumps on the outer edges of the rash. This rash requires treatment with medication.
- Heat rash or prickly heat is caused by the blockage of the pores that lead to the sweat glands. It is most common in very young children but can occur at any age, particularly in hot and humid weather. An infant does not sweat. The sweat is held within the skin and forms little red bumps or occasionally small blisters.
Erythema toxicum can cause flat red splotches (usually with a white, pimple-like bump in the middle) that appear in up to half of all babies. This rash rarely appears after 5 days of age, is usually gone in 7 - 14 days, and is nothing to worry about.
- Baby acne is caused by exposure to the mother's hormones. Red bumps, sometimes with white dots in the center, may be seen on a newborn's face. Acne usually occurs between 2 and 4 weeks of age, but may appear up to 4 months after birth and can last for 12 - 18 months.
Cradle cap (seborrheic dermatitis) causes greasy, scaling, crusty patches on the scalp that appear in a baby's first 3 months. It usually goes away by itself, but some cases may require treatment with medication.
- Hives are red welts that appear to move around on the body. For example, if you drew a circle to mark one of the welts, a few hours later that circle would not have a welt in it, but there would be welts on other parts of the body. They differ in size and shape. Hives may last for a few weeks. The cause is uncertain.
- Eczema is a condition of the skin in which areas are dry, scaly, red (or darker than normal skin color), and itchy. When it goes on for a long time the areas become thickened. It is often associated with asthma and allergies, although it can often occur without either of these. Eczema often runs in families.
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Keep the skin dry. Change wet diapers as quickly as possible. Allow the baby's skin to air dry as long as is practical. Launder cloth diapers in mild soap and rinse well. Avoid using plastic pants. Avoid irritating wipes (especially those containing alcohol) when cleaning the infant.
Ointments or creams may help reduce friction and protect the baby's skin from irritation. Powders such as cornstarch or talc should be used cautiously, as they can be inhaled by the infant and may cause lung injury.
If your baby has a yeast diaper rash, the doctor will prescribe a cream to treat it.
Heat rash or prickly heat is best treated by providing a cooler and less humid environment for the child.
Powders are unlikely to help treat heat rash and should be stored out of reach of the infant to prevent accidental inhalation. Avoid ointments and creams because they tend to keep the skin warmer and block the pores.
Erythema toxicum is normal in newborn babies and will go away on its own in a few days. You do not need to do anything for it.
White or clear milia/miliaria will go away on their own. You do not need to do anything for it.
For hives, talk with your doctor to try to find the cause. Some specific causes require prescription medication. Antihistamine medications may help stop the itching.
Normal washing is usually all that is necessary to treat baby acne. Use plain water or mild baby soap and only bathe your baby every 2-3 days. Avoid acne medicines used by adolescents and adults.
For cradle cap, wash the hair or scalp with water or a mild baby shampoo. Use a brush to remove the flakes of dry skin. If this cannot be removed easily, apply an oil to the scalp to soften it. Cradle cap usually disappears by 18 months. If it does not disappear, it becomes infected, or if it is resistant to treatments, consult your doctor.
For skin problems caused by eczema, the keys to reducing rash are to reduce scratching and keep the skin moisturized.
- Keep the baby's fingernails short and consider putting soft gloves on the child at night to minimize scratching.
- Drying soaps and anything that has caused irritation in the past (including foods) should be avoided.
- Apply a moisturizing cream or ointment immediately after baths to avoid drying.
- Hot or long baths, or bubble baths, may be more drying and should be avoided.
- Loose, cotton clothing will help absorb perspiration.
- Consult a doctor if these measures do not control the eczema, (your child may need prescription medicines) or if the skin begins to appear infected.
While the majority of children with eczema will outgrow it, many will have sensitive skin as adults.
When to Contact a Medical Professional
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Call your child's health care provider if your child has:
- A fever or other unexplained symptoms associated with the rash
- Any areas that look wet, oozing, or red, which are signs of infection
- A rash that extends beyond the diaper area
- A rash that is worse in the skin creases
- A rash, spots, blister, or discoloration and is younger than 3 months
- No improvement after 3 days of home treatment
- Significant scratching
What to Expect at Your Office Visit
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The health care provider will perform a physical examination. The baby's skin will be thoroughly examined to determine the extent and type of the rash. Bring a list of all the products used on the child's skin.
You may be asked questions such as:
- When did the rash start?
- Did it begin suddenly (within hours) or slowly and gradually?
- Did symptoms begin at birth or in infancy? What age?
- Did symptoms begin after a fever occurred and was relieved?
- Did the rash occur after skin injury, bathing, or exposure to sunlight or cold?
- What does the rash look like?
- Are there pinpoint red spots?
- Does it look like small red areas or blisters?
- Does it look like bruises?
- Does it look like hives (red welts that come and go on different parts of the body and are very itchy)?
- Does the skin look dry and tough?
- Is the rash scaling or crusting?
- Where on the body does the rash occur?
- Is the rash spreading to other areas?
- What other symptoms are also present?
- What type of soaps and detergents do you use?
- Do you put anything on the skin (creams, lotions, oils, perfumes)?
- Is your child taking any medications? How long has the child taken them?
- Has your child recently eaten any new foods?
- Has your child been in contact with grasses/weeds/trees recently?
- Has your child recently been sick?
- Does your child or anyone in your family have allergies?
- Do any skin problems run in your family?
Tests are seldom required but may include the following:
Depending on the cause of the rash, antihistamines may be recommended to decrease itching. Antibiotics may be prescribed if there is a bacterial infection.
The doctor may prescribe a cream for diaper rash caused by yeast. If the rash is severe and not caused by yeast, a corticosteroid cream may be recommended.
For eczema, the doctor may prescribe ointments or cortisone drugs to decrease inflammation.
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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