Neonatal rashes

Erythema Toxicum

• Benign, self-limited (1wk) rash that occurs in 50% of newborns
• Erythematous macules develop on face, trunk, extremities
• No treatment necessary

Neonatal Acne

• Occurs around 3rd week of life
• Commonly on face, may also see on trunk
• No treatment necessary (resolves by 3rd month of life)

Seborrheic Dermatitis

• Starts between 2-6wk of life; improves by 6 months
• Greasy yellow-red scales
• Proclivity for scalp (cradlecap), but may find around ears, cheeks, neck
• Not pruritic
• DDX
  • Atopic dermatitis, tinea capitis, psoriasis
• Treatment
  • Salicylic acid shampoo (Sebulex) OR
  • Application of mineral oil followed by washing and removal of scales w/ comb

Atopic Dermatitis

• Must distinguish from seborrheic dermatitis
  • Occurs between 2-6mo (somewhat later than seborrheic dermatitis)
  • Pruritic (may manifest as fussiness) vs seborrheic (not pruritic)
• Dry skin, erythematous papular lesions
• Face most commonly involved; nose and diaper areas spared
• DDX
  • Seborrheic dermatitis, scabies
• Treatment
  • Identify and eliminate triggers
  • Reduce drying of skin
  • Liberal application of emollients (vaseline)

Diaper Dermatitis

• Contact dermatitis VS candidal dermatitis
• Contact dermatitis
  • Erythematous, macular or papular, w/ well demarcated borders
  • Treatment
    • Good hygiene, air drying, use of barrier creams (zinc oxide)
• Candidal dermatitis
  • Erythematous w/ papular and pustular lesions and scaling around margins
  • Classic finding is "satellite lesions"
  • Must examine for oral thrush
    • If present: Oral nystatin 2mL QID infants, 4-6mL QID children
      • Administer for up to 2d after resolution of oral lesions
  • Treatment
    • Nystatin cream 100K U/gram TID x10-14d
    • If use zinc oxide must apply after nystatin
    • Hydrocortisone 1-2% after nystatin, before zinc oxide, may be used for severe lesions

See Also

Rashes (Peds)