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Rashes are very common in newborns, where during the first four weeks of life, the neonatal period involves various skin related skin problems but most of them are innocent and transient. The skin is the largest organ of the body and during pregnancy, the baby’s skin is protected in the womb whereas after birth, it takes time for gradual adaptation to the outside world as this skin is very sensitive, thin and delicate as the barrier system is not fully formed, hence the skin is more susceptible to trauma, irritation, infection and it also absorbs topical medications more than a mature adult skin.
In an interview with HT Lifestyle, Dr Reshma T. Vishnani, Consultant Dermatologist, Trichologist and Aesthetic Dermatologist at Kokilaben Dhirubhai Ambani Hospital, Mumbai, advised, “The use of topical steroids, which are present in over the counter creams or non-doctor prescribed creams, should be done with extreme caution! Most skin conditions in the neonatal stage are physiological, including small white pimples on the face and/or body, pigmentation on the body, temporary redness, flaky skin on the face and scalp, flaking on the scalp. Most of these conditions resolve on their own with basic skin care using mild cleansers and moisturizers so as not to aggravate the skin.”
He said that if the following conditions or symptoms persist, one should consult a dermatologist:
- Skin that is persistently dry, rough, scaly, or cracked, even after moisturizing, should be a cause for concern.
- Red spots on the skin, these may remain in one place for several days or may be temporary.
- Inflamed itchy skin that includes patches of skin that are oozing or scaly; children may rub or scratch their skin which indicates discomfort or irritation.
- Temperature sensitivity: Babies with dry sensitive skin may react strongly to changes in temperature, such as getting dry patches on the skin in cold weather or turning red when exposed to heat or even sunlight. These babies are sensitive even to mild exposure to sunlight.
- Babies with sensitive skin are more prone to allergies to certain fabrics, detergents, fragrances or even skin care products. They may suddenly develop red itchy spots, hives, redness, swelling or itching.
- Skin reactions to products or clothing: This problem is very common in babies with sensitive skin, these babies should always be dressed in loose cotton clothes.
- These babies may also be sensitive to mild soaps, lotions, or chemicals in diapers, and may have persistent diaper rash that is not related to the tightness of the diaper or to being in a moist diaper.
Dr. Reshma T. Vishnani explains, “There are many chronic diseases like eczema, psoriasis that have the above symptoms. Also, some temporary conditions like inflammatory dermatitis or secondary infections can also present in the same way. So, if the baby is feeling uncomfortable – crying, fussing on touch or not drinking milk – it could be a sign of a primary or secondary infection and should be seen by a dermatologist as soon as possible. One thing we Indians do to spoil the sensitive skin of babies is home remedies, whether it is using curd or milk for bathing, or using gram flour or chickpea flour as a “natural exfoliant” to make the baby fair or remove hair. This should be highly discouraged. Rubbing or massaging newborns harshly is harmful in many ways and should not be done.”
Dr. Soma Sarkar, MBBS, MD – Dermatology, explained, “Babies are born with sensitive skin that is about three times more delicate than adults. The thin and permeable nature of their skin makes them more vulnerable to rapid loss of moisture. To ensure that this delicate outer layer is well protected, it is important to protect and take special care of baby’s skin. While most babies are born with sensitive skin and facial skin irritation, some babies have or may have extremely sensitive skin that requires special care and attention.”
He elaborates, “One such example of a sensitive skin condition is atopic dermatitis (AD), the most common form of eczema, a chronic inflammatory skin disease that has a profound impact on millions of children. The Indian Academy of Pediatrics (IAP) has created standardized guidelines on pediatric skin care, which also covers sensitive conditions. According to the IAP, children with AD are usually genetically prone to impaired epidermal barrier function and immune dysregulation. It is an itchy chronic skin condition that presents periodically with a distribution of skin lesions based on age.”
Noting that sensitive skin conditions like eczema often run in families, Dr Soma Sarkar revealed that if one of the parents has the condition then the child is likely to have it too. “However, several other factors such as environmental triggers, dry weather and over-bathing contribute to or exacerbate these conditions. Sensitive skin conditions are becoming increasingly common in children. About 60% of children with atopic dermatitis develop symptoms in the first year after birth, and 90% develop symptoms by the age of 5,” she added.
They concluded, “Dry skin is often a sign of sensitive skin. However, other symptoms of eczema or AD include chronic itching that often appears as a red, dry rash on a baby’s cheeks, forehead or mouth that indicates a compromised skin barrier. Although eczema skin conditions can vary from one baby to another, in babies with lighter skin, it usually occurs as red patches while babies with darker skin may have a purple, brown or gray rash. But these patches are almost always dry, itchy and rough.”
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