The Mirror's Health , Lifestyle and Fashion
What is the cause of rashes on my baby’s face?
The rash goes and comes at different spots.
It seems to have some fluid in it with some redness around it. My doctor tells me not to worry because it will go completely. Please what is the cause of this rash?
Advertisement
Amina.
Dear Amina, The rash you describe fits a type of rash seen in newborn called erythema toxicum neonatorum (ETN). It is a common skin rash that affects healthy newborn babies. It is not serious, does not cause the baby any harm and clears up without any treatment just as your doctor told you. It is sometimes known as erythema toxicum, baby acne or toxic erythema of the newborn. The name erythema toxicum neonatorum is confusing because the condition is not toxic. It is also not the same as the acne that affects young people and adults.
This rash is a self-limiting, asymptomatic skin condition that only occurs during the newborns particularly in the first month of life. The rash is usually small, raised and sometimes fluid-filled and usually surrounded by a distinctive diffuse, blotchy, red halo. Individual lesions are transitory, often disappearing within hours and then appearing elsewhere on the body.
Typically, the rash is seen in term newborns of average birth weight. It presents in newborns aged three days to two weeks. Although it can occur in the first 48 hours, approximately 90 per cent of cases occur after 48 hours.
The underlying cause of this rash is uncertain. Various mechanisms have been advanced to explain the rash, some mythical, others scientific.
Ancient physicians believed this eruption to be nature's method of cleansing the child of impure blood of the mother. Others attributed the condition to "be as a result from constipation when the newborn has not adequately passed the meconium ( fetal stool)."
Scientifically, the cause is thought to be an activation of the immune system in the newborn. Some neonates are more sensitive than others and develop red spots all over the body. Another school of thought posits that the rash is from hypersensitivity to detergents in bedsheets and clothing even though the connection remains unproven.
The characteristic presence of eosinophils (a type of white blood cells) within the lesions has led some investigators to attribute this condition to an allergy. This hypothesis is supported by cases in which premature neonates have infrequent eruptions that takes longer to resolve, usually within weeks after birth as the neonatal immune response matures.
Diagnosis is usually on clinical grounds and does not need any elaborate laboratory test. Sometimes, there may be the need to differentiate it from other common skin rashes in newborns such as herpes simplex rash. In uncertain cases, a scraping of the lesion can be taken and the fluid examined under the microscope. Herpes lesions will have a positive direct antibody test.
The fluid from erythema toxicum lesions will show many eosinophils. In addition, sometimes we need to differentiate it from other skin conditions in newborns such as impetigo, neonatal chicken pox and infections which are relatively more dangerous.
Because the eruption is transient and self-limiting, no treatment is indicated. Parents need to be educated not to apply any powder particularly the Korle Bu powder which tends to be a bit harsh on the fragile newborn skin. Application of steroid-based cream has not shown any benefit even though some people think it is allergic in origin.
Bathing with antiseptic soaps or baths to prevent bacteria taking advantage to cause infections is recommended and normal skin care for babies is the order of the day for this condition.
The writer is a member of Paediatric Society of Ghana.
E-mail: [email protected]