As a nurse, it’s important to identify rashes and know when they may indicate something more serious, especially if you plan to work in a primary healthcare setting or children’s ward.
For example, Measles (which we won’t cover in this post because it’s uncommon in newborns). Measles commonly presents as a rash and could be life-threatening. It needs to be identified and reported to prevent outbreaks.
Let’s have a look at some rashes that commonly affect neonates.
Heat Rash vs. Sun Poisoning
Heat rash
Heat rash is a common skin rash that occurs when a baby becomes too hot. This happens when sweat becomes trapped under the baby’s skin, giving it a bumpy, rash-like appearance.
Heat rash is usually quite itchy and appears in skin folds such as in the neck, behind the knees, in the elbow bends and in the groin (all the places that get hot and sweaty).
Treatment involves cooling the skin, usually by removing clothing, putting the baby in a cool bath, and using diaper rash cream on the affected area. Usually, a heat rash resolves without any medical treatment within about 3–5 days.
Sun poisoning
Sun poisoning is an extreme form of sunburn. I really hope that you never see this on a newborn because small babies should be kept out of the sun!
This type of “rash” appears as blistered, peeling skin with extreme redness and swelling. Often, sun poisoning is also accompanied by other symptoms such as nausea, vomiting, and lethargy.
A baby with sun poisoning would need to be admitted for fluid management. This would be one example of a “rash” that is life-threatening.
Diaper Rashes
Just as the name leads you to believe, this is a rash of the diaper area.
A diaper rash is really common and has a couple of pathogens that may cause it. A diaper rash is often caused by friction or a wet environment, which damages the skin and allows these pathogens to infect the area. The type of diaper rash depends on what has caused it. Below, I’ll briefly discuss the most common types of diaper rash.
Irritant diaper rash
This is the most common type of diaper rash. It is caused by an irritant “burning” the skin. It is most often caused by wet or soiled diapers that are not changed often enough and irritate the skin after being exposed to this irritant for an extended period of time.
It presents as red areas of skin that may peel or weep depending on the rash’s severity.
A diaper rash like this can be treated at home with over-the-counter medication and some daily diaper-free time.
Strep diaper rash
A strep diaper rash is caused by the group A streptococcus bacteria (the bacteria that causes strep throat).
This diaper rash is caused much like an irritant diaper rash. That means the skin is irritated by wetness, for example, and is then infected by the strep bacteria from the caregiver’s hands or on the skin. It’s almost like taking irritant diaper rash one step further.
This also appears as a red, weeping rash with red pus-filled lesions. It usually looks worse than the run-of-the-mill diaper rash. When these lesions burst, they may also leave scaly skin.
Like other bacterial infections, a baby with a strep diaper rash may also present with fever, fatigue, and lymphadenopathy. This type of diaper rash needs a course of antibiotics to heal.
Thrush diaper rash
A thrush diaper rash is caused by candida, a fungus that occurs naturally on the skin of humans.
This type of rash appears as red spots on the skin of the diaper area.
As with a strep diaper rash, if a baby’s skin becomes irritated – candida, which is naturally present on the skin – may infect the area and spread.
This diaper rash may resolve on its own or can be treated with an over-the-counter antifungal cream.
Prevention of diaper rashes
As I’m sure you’ve now learned, diaper rashes are caused by the skin becoming irritated after frequent and long exposure to irritants such as urine and stools. Thrush and strep diaper rashes are caused when pathogens infect the irritated area.
While not much can be done to prevent pathogens from infecting the irritated area—except maybe good hygiene and handwashing practices—if there is no irritation, it might be harder for a pathogen to infect. Therefore, make sure that you or the caregiver change diapers frequently. It’s also your responsibility to educate parents on the importance of frequent diaper changes.
Another good protective measure for the prevention of diaper rashes is the use of barrier cream. Make sure that you are using a good amount of barrier cream and educating parents to do the same. Barrier cream should be applied in a thick layer to all areas of the skin that will be in contact with the diaper. Applying a barrier cream means the wet or soiled nappy is in contact with the barrier cream, not the skin. Hence the name, barrier cream.
Milk Rash
A milk rash is actually an allergy to cow’s milk or cow’s milk proteins. This allergy can be caused by cow’s milk proteins passed to the baby in breast milk or from a baby directly consuming cow’s milk or dairy products.
This type of rash can have several presentations. It can appear as a small bumpy rash, hives, a weeping rash, or eczema. It is often accompanied by other symptoms such as vomiting, diarrhea, and sometimes wheezing.
The treatment for a milk rash is to eliminate exposure to cow’s milk. If a baby is still breastfeeding, the mother must exclude dairy from her diet completely. If the baby is formula-fed or eating solids, they will need to be placed on an allergy formula, and dairy must be cut out of their diet.
You have an important role in educating a parent who has a child with a milk allergy. If a mom is breastfeeding, it’s important to make sure that she understands that she will need to cut dairy from her diet completely.
Erythema Toxicum
Erythema Toxicum is a common skin rash that occurs in the first few days after birth and resolves within a few weeks. It’s unknown what causes it, but it is thought to be related to the immature immune system.
It presents as small fluid-filled bumps and is most commonly seen on a baby’s face, chest, arms and legs. It does not cause any discomfort to a baby and disappears after about two weeks.
No treatment is necessary for Erythema Toxicum unless it does not clear on its own.
Baby Acne
Baby acne is exactly what it sounds like—hormonal acne on a baby’s face. This is caused by the mother’s hormones circulating in the newborn after birth.
It presents as pus-filled lesions on a baby’s face.
Usually, baby acne resolves on its own without any intervention, but if it is prolonged, doctors sometimes prescribe medicated ointment. It’s important to educate caregivers on how to wash a baby’s face correctly, encourage them to always use a clean washcloth, and remind them to avoid using creams on the face unless prescribed by a doctor.
Conclusion
The key takeaway regarding rashes is that there are so many of them and what feels like unlimited causes. It’s important to remind parents that rashes are very rarely dangerous. They can often be treated at home or with over-the-counter medication. Let parents and caregivers know that if a rash is persistent or getting worse, even after trying at-home or over-the-counter methods, it may help to visit a doctor.
