What could be purer and sweeter than a baby’s skin? Yet infants often present with a variety of rashes and other skin issues, even in the first few days of life, says Dr. Nikhil Menon, an assistant attending pediatrician at NewYork-Presbyterian Hospital and assistant professor of clinical pediatrics at Weill Cornell Medicine.
Newborn skin is extremely sensitive, Dr. Menon explains, asking us to imagine the following: “Your baby’s skin has been surrounded by a stable mix of water and nutrients for 9 months, and then suddenly, from the moment of birth, it’s exposed to a comparatively dry environment long with dust, pollen and other unfamiliar particles.
“That overwhelmingly new environment accounts for many of the rashes we see in newborns,” he continues. “Luckily, most of these tend to be transient and harmless, and they usually don’t require treatment.”
In what follows, Dr. Menon answers your questions about infant rashes and other skin conditions, from baby acne to cradle cap, diaper rash and, most significantly, eczema.
Neonatal acne typically occurs when an infant is between 2 and 6 weeks old, and it can last for a couple of weeks. In most cases, no treatment is needed, as it will usually resolve on its own. But sometimes, for babies who have a bit more acne, we recommend daily washing wit a gentle cleanser. Avoid scented cleansers or lotions, as these can irritate your baby’s skin.
Many newborns are affected by cradle cap, also known as seborrheic dermatitis. This condition mainly affects the scalp. It looks like dandruff or a dry, scaly area on the skin, but it’s completely harmless, just as it is in adults. “We either do nothing and let it run its course; or we may recommend applying baby oil and combing out the flakes with a soft brush,” Dr. Menon says. “However, that is usually done for cosmetic purposes, with no real medical benefit to your baby.
“For severe cases of cradle cap, I recommend using a mild steroid cream or an antifungal shampoo,” he continues. “But these treatments should only be administered under the guidance of a pediatrician.”
Diaper rash is perhaps the most common skin problem you’ll encounter as a new parent. It has two main causes. The first is too much moisture. The moisture-type rash can be prevented by changing your baby’s diaper frequently and using a zinc-containing cream between changes. Zinc cream acts as a barrier between a wet diaper and your baby’s skin, helping to prevent any skin breakdown.
But once a rash develops, the most effective treatment is exposure to open air. “I usually recommend leaving the baby diaper-free for as long as parents are willing to hold out after each change,” Dr. Menon says.
If these measures don’t work, consider a visit to your pediatrician, who may diagnose the second type of diaper rash: a fungal infection. Much less common than the moisture-type rash, it requires treatment with a prescription anti-fungal cream to get better.
Eczema (atopic dermatitis), a chronic, inflammatory skin condition, is surprisingly common in babies and young children, usually appearing before age 5. It can even affect infants as young as 2 months old. Its telltale signs are dry, scaly patches of skin that can be red and itchy.
“The good news is that eczema has been thoroughly researched for decades,” says Dr. Menon. “Here’s what we’ve learned: It is caused by skin barrier dysfunction, meaning that the junctions between affected skin cells don’t hold together as tightly as they should. The result is that moisture is allowed to escape through the areas between the skin cells, and irritants from the outside environment are allowed to enter.”
Eczema is ultimately caused by a combination of genetic and environmental factors, as well as a dose of chance, he says. It’s a variable condition that affects everyone differently. It can have many triggers, none of which cause eczema but can make already existing eczema flare up.
Common triggers include chemical irritants, including ingredients in many soaps, detergents, sunscreens and lotions; and environmental irritants, such as pollen and dust mites. Heat and sweating also may trigger an eczema flare.
But contrary to one popular belief, food triggers are very uncommon. “In the rare instance where there’s a potential food trigger, we work closely with pediatric allergists or dermatologists to identify the cause of the flare rather than rush to eliminate foods from your child’s diet, an approach that can do more harm than good,” Dr. Menon says.
One more myth-buster: There is no evidence to suggest that pregnant or breastfeeding mothers can prevent food allergies or eczema in their babies by changing their own diet.
Pediatricians typically use a stepwise approach when treating your child’s eczema. “We start by recommending small interventions—regular moisturizing with Aquaphor or Eucerin, for example—and build from there to see what works,” says Dr. Menon. The usual plan, even for young infants, also includes short daily baths with a gentle, fragrance-free cleanser and warm water followed by moisturizing to help seal in moisture. Thick moisturizers like Aquaphor and petroleum jelly tend to work better than thinner lotions.
When flare-ups occur, topical medications can help quiet inflammation by reducing redness and itching. We usually start with a mild, over-the-counter topical steroid cream, Dr. Menon explains, but sometimes a stronger, prescription medication is needed to bring an eczema flare under control.
“Let me address parents’ concerns about steroids, which tend to have a bad name,” Dr. Menon says. “When used responsibly, they are quite safe and effective, even in infants as young as 2 or 3 months old. The steroid creams we use for eczema are in a class called corticosteroids, which help ease inflammation and tame eczema’s characteristic itch. The side effects most parents are worried about tend to be seen with long-term use, and mostly with oral steroids as opposed to steroid-containing creams.
“However, when used for long periods of time, even mild topical steroids can cause issues such as lightening or thinning of the skin,” he adds. “Therefore, we recommend checking with your pediatrician even before using over-the-counter steroid creams.”
Sometimes, though, these medications aren’t enough to keep your child’s eczema under control. That’s when pediatricians refer parents to their colleagues in pediatric dermatology, who can recommend alternate therapies.
For many children with eczema, the condition eventually resolves. “We often see symptoms starting to fade at around age 4 or 5. But for some, it may improve somewhat or not at all,” Dr. Menon says. “If your child continues to suffer from eczema after that, we’ll deal with it if and when that time comes.”
One thing is clear: there’s no single quick fix for eczema. Taking care of your child’s eczema is all about having a good skincare plan, avoiding environmental triggers and using medication when needed.
“For babies without eczema—and this applies to all newborns, because eczema doesn’t typically show up for a couple of months—we recommend sponge baths right after birth until the umbilical stump has fallen off,” he advises. “Once that has happened, and it’s completely dry, parents can give their baby a full-immersion bath, using plain warm water alone. I usually recommend twice-weekly baths.”
For babies with eczema, daily baths seem to be beneficial. But it’s important to keep bath times short, use a mild cleanser and avoid any irritants (like bubble bath). Afterward, make sure to pat your baby’s skin dry and apply a thick moisturizer all over.
Whether your baby has eczema or not, bath time is also bonding time—a brief, fun ritual for parents and child alike!
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