The skin is a very remarkable organ in the human body. Although it often goes unnoticed, it performs a variety of jobs. It is the vital protective wrapping for all of the body’s structures. As it covers bones, muscles, blood vessels and internal organs it helps maintain body temperature and hydration. Through the sweat mechanism it also plays a role in the maintenance of the salt balance in the body. Pigment production helps defend the body from harmful sunburn.
The intact skin barrier prevents infection by bacteria, parasites, fungi and other invaders. The sensitive nerve endings on the skin give essential signals to the brain about the environment such as temperature, humidity and texture. Proper care of the skin is essential to the health and comfort of all of us, but because immature skin is thin and vulnerable, infants and babies need it the most.
Very young infants have very delicate skin. Preemies have paper thin skin that breaks down from the slightest friction. Full term newborns have skin that is less than 1/3rd the thickness of that of an adult. This means that it is more prone to sunburn, irritation in the diaper area and other rashes. There are different skin types which are determined by the types of skin that the parents have. Babies with darker hair and complexions are less delicate than the blond or red haired infants.
All newborns must be kept in the shade on sunny days, this means long sleeves, covered legs and feet or a good umbrella. Sunscreens are not effective on such thin skin.
In the newborn period there are often marks on the skin. If these birthmarks appear blue or red they are caused by clusters of blood vessels in the skin. The most common red ones are on the eyelids and nose and lips and the back of the head. These are called flame nevi. They are usually gone by the first birthday. The ones identified as “strawberry hemangiomas” can often be prevented from growing thicker and larger by massaging the mark several times a day. If they are very large or if they cover the eyes they need medical attention. Laser treatment is often therapeutic. Brown or tan marks are caused by pigments in the skin. These do not always appear at birth, but once they appear they are usually permanent. Light ones never need to be removed. Very dark ones that are also large must be monitored as the baby grows. Some of them will have to be removed in adolescence.
Newborn skin problems
The most common skin problems in newborns are diaper rashes, baby acne and cradle cap.
Newborns have frequent and loose bowel movements which can easily irritate their skin. Soiled diapers should be changed as soon as they are detected. (Urine alone is rarely irritating because of the new gel technology in the disposable diapers.) If a baby soils his diaper during sleep or is inadvertently left in a soiled diaper too long, the skin can become red. This contact rash can be both prevented and treated by using a barrier to keep the skin from being further irritated while it is healing. After a bowel movement, the skin should always be cleaned by either a little water or lotion on a tissue or baby wipes. Very sensitive skin can be irritated by the chemicals in the wipes or even the chemicals in the diaper. When this happens, changing brands often helps.
In baby boys, a cornstarch based powder applied to the area before closing the diaper works very well. In girl babies, using powder is not a good idea. The powder gets inside the genital area and can cause a problem. A cream is needed. Most barrier creams have either a white zinc oxide base or a clear petroleum jelly base. All of these provide protection but some seem to work better than others. Do not use Desitin in girl babies because there is powder mixed into the cream.
If the treatment is not effective and the diaper rash develops pimples or dots or if the skin breaks down, a doctor should be consulted. Sometimes a medicated cream is needed.
Baby acne appears on the baby’s face at around one month of age. It is not really acne but it looks like it. This pimply red rash usually goes away on it’s own over time. The use of an anti fungal cream such as Spectazole will sometimes be needed in very severe cases to get rid of the yeast (not the one that causes thrush) that causes this common problem.
Cradle cap is the accumulation of a greasy scaly substance on the scalp and forehead. The old fashioned method of applying oil or Vaseline to the scales and scrubbing it off an hour later with a washcloth and baby shampoo works well. A comb can be used to scrape the oiled scales off gently. If the problem is persistent, dandruff shampoos can be used. The scales are sometimes invaded by the same yeast as the baby acne and using anti fungal shampoo can help. Occasionally, application of 1% hydrocortisone cream is needed.
The question of how often to bathe a newborn and what to use for soap often comes up. It is generally felt that too much bathing can dry the skin and cause cracking and peeling. Most of the time, 2–3 baths a week are enough for a newborn. The soap used should be fatty, like unscented Dove. The “baby bath” liquids are not really good for the skin. After bathing and wrapping and patting (not rubbing) the skin with a towel, a lotion could be applied while the skin is still a little damp. This traps the water back into the outer layers of skin. Sensitive skin needs unscented and uncolored lotion. One of the best moisturizers for very dry skin is Vanicream applied after the bath. Applying oil all over the skin is not a good idea since many babies break out from the occlusion of the pores.
It is very important that infants should be dressed or undressed appropriately for the weather. Overheating and over wrapping can really be harmful to the baby. Always dress the baby in about the same level of warmth that you need yourself. If your little baby is sweating you have probably overdressed him.
After the first 3 months of life the baby’s skin is less delicate but there are certain problems that become more evident. The most common ones are eczema and chronic diaper rashes.
Eczema is an itchy rash that appears as patches of reddened skin which is dry and breaks down. The cause is not always known, but 70% of the time it is an allergy to a particular food in the child’s diet. The most common foods that can cause eczema are cow’s milk, egg whites, soy, peanuts, tree nuts and fish. Infant formulas are based on either milk or soy. Breast milk sometimes exposes babies to all of the foods in the mother’s diet. Changing the type of formula, or altering the diet of the baby or the breastfeeding mother to remove all or some of the foods often clears up the eczema. Once a problem food is identified it should be stopped for about 6 months and then tried again. Most food allergies disappear by that time.
There are differing opinions as to how to treat eczema. The "dry" method advises little or no contact with water and the application of Cetaphyl lotion to clean the skin. The "wet" method is to use water to soften the skin and then to apply moisturizer. One of the most effective "wet" methods of treating dry skin with eczema is to give daily 20 minute baths followed by the application of Vanicream while the skin is still damp. Any area that is particularly red or itchy is rubbed with 1% hydrocortisone ointment 2–3 times a day until it improves. If the eczema starts to weep and crust, an antibiotic ointment may be needed. Eczema that is more severe needs to be treated by a physician.
Chronic diaper rashes
Any rash that does not improve with these basic measures should be checked by a physician.
Most diaper rashes are caused by contact sensitivities. Those that do not clear up with barrier creams and powders are invaded by the yeast called Monilia. Yeasts love to grow in moist skin so the most vulnerable areas are the diaper area and the places where skin folds on skin, such as the chubby creases in the groin and under the chin.
Monilial rashes usually have solid red areas with satellite dots in the periphery. Powder helps to keep these creases dry, but often a medicated cream is needed. Chlortrimazole is very effective in most cases.
If the baby’s stools are very loose and the diaper area is red, sometimes a probiotic, such as Culturelle, ˝ capsule once a day or Florastor one packet 2x a day, will improve the stools and help to clear up the rash.