During birth, the skin is covered with a whitish chalky foetal smear. In the first few days of the baby's life, its colour becomes increasingly pink and all sorts of changes and eruptions can be seen on the skin. Some are physiological and do not require any treatment, while others may be symptoms of a disease.
A very common skin complaint in newborns is nappy rash. Among its causes are contact and seborrhoeic dermatitis, yeast infection or atopic eczema. All of these contribute to skin irritation, which results in inflammation. Symptoms also appear if nappy changes are too infrequent or if there is diarrhoea. The rash that appears is the result of the irritating effect of urine on the skin in susceptible children. The eruptions appear on the buttocks, perineal area, lower abdomen and upper thigh. The lesions are erythematous and may resemble flare-ups. They respond very well to treatment with protective emollients; the need for a topical steroid is extremely rare. The resolution of symptoms is accelerated by leaving the child without a nappy.
Seborrhoeic dermatitis is another skin complaint that occurs during the first 3 months of life. It begins on the scalp in the form of an erythematous, scaly eruption. The resulting scaly masses form a thick, yellow, adherent coating commonly referred to as 'dandruff'. The scaly lesions can also occupy the face, the retroauricular area and then the flexural area. These lesions do not itch and do not cause distress to the child. They usually disappear with the application of emollients and special ointments containing low concentrations of sulphur and acetylsalicylic acid.
Approximately 20 per cent of children in infancy also develop atopic dermatitis. Genetically determined skin barrier insufficiency plays a major role in the development of this disease. A family history of asthma or allergic rhinitis is usually positive. Breastfeeding may slightly delay the appearance of skin lesions, but does not prevent the development of the disease. The main symptom of atopy is persistent itching leading to scratching and exacerbation of the rash. The lesions take the form of oozing and scab-covered erythematous lesions. Among the methods of treatment and symptom relief are avoidance of irritants, emollients, topical corticosteroids, immunomodulators, occlusive dressings, antibiotics and an elimination diet.
As can be seen, rashes in infancy are extremely common and usually resolve with age or after the use of emollients. Any rash that is of concern to the child and causes systemic symptoms requires medical consultation.