Healthy Mama: Identifying that scary newborn rash

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By Dr. Matthew Steed, Mercy family practice doctor and obstetrician (and father of two)

It’s nearly Halloween and what’s scarier than a newborn with a rash?

Although most newborn rashes are unsightly, they are self limiting, and do not require any test to diagnose.

Seborrheic Dermatitis “cradle cap”, Cutis Marmorata “cold rash” and Transient Neonatal Pustular Melanonsis are all common rashes, but the “flea-bitten” rash, “newborn acne”, milia and “newborn heat rash” are the ones I am most frequently asked about.

Erythema Toxicum Neonatorum is commonly called the “flea-bitten” rash. Affecting 40-70 percent of newborns it is the most common newborn rash. You may have seen  a newborn with the blotchy red lesions with a raised nodule in the center and thought “I wonder what bit that baby?” The lesions appear on the face, trunk, arms and legs. Like many newborn rashes the cause is unknown, no treatment is needed and should resolve in about a week. Just in time for Holiday Pictures!

Acne Neonatorum occurs in 20 percent of newborns and is most frequently seen on the forehead, nose and cheeks. Maternal and newborn hormones stimulate glands in the skin resulting in inflammatory papules and pustules which are the key feature of “newborn acne.”  Treatment is seldom needed but in severe cases a healthcare provider might use a benzoyl peroxide lotion or a steroid cream.  Acne Neonatorum will resolve without scarring but can last for months. Go ahead and get the pictures you can always have them photo-shopped. 

Milia (sometimes called “milk bumps”) is almost a cute rash.  1-2 mm pearly white papules most commonly found on the forehead, cheeks, nose and chin.  It is the rash most people think of when someone says “newborn rash.”  Milia is caused by retained keratin, usually resolves in the first month of life and without scarring or treatment. 

Miliaria rubra or newborn “heat rash” like Milia is caused by immature skin structures but unlike Milia, Miliaria rubra is not so cute.  Miliaria occurs on the covered portions of the skin due to overheating.  The obstructed sweat glands cause red raised papules.  The treatment involves avoiding overheating, removal of excess clothing, and cooling baths.  There are other forms of Miliaria but the key is they usually occur on covered portions of the skin as a result of overheating.

It is important to note that although there are many self-limiting, non-harmful newborn rashes, a rash could be a sign of a bacterial, viral or fungal infection.

If your newborn is not feeding well, fussy or showing other sings of newborn stress please make an appointment with your medical provider. I would rather see 100 babies with a self-limiting rash than miss a chance to diagnose an infection or other illness. 

Ready for a quiz? Name that rash:

How did you do? Here are the answers: 1. ETN (“flea-bitten” rash) 2. Acne 3. Milia 4. Miliaria

Dr. Steed’s number one passion is to care for the pregnancy and birthing needs of women. You may call him at the Mercy clinic at 479-338-5555 to begin your prenatal care and let him help you enjoy your pregnancy journey. His office is located in the Mercy Physician’s Plaza just off Interstate 540 in Rogers.

MERCY2 does not provide medical advice, diagnosis or treatment. This content is for informational purposes only and isn’t a substitute for professional medical advice. Always talk to your doctor if you have questions about a medical condition. Don’t delay getting professional medical advice because of something you read online. This website doesn’t necessarily recommend or endorse any specific tests, doctors, products, procedures or opinions discussed on the site.