Definition

• Common questions asked about normal skin rashes in newborns
• Note: Mongolian spots and birthmarks are not covered here

Health Information

Topics Covered

Go directly to the topic that relates to your question for advice.

1. Acne – small red bumps on the face
2. Drooling Rash – rash around the mouth and on the chin (onset week 3 or 4)
3. Erythema Toxicum – red blotches with small white "pimple" in the center (onset day 2 or 3)
4. Forceps or Birth Canal Injury (present at birth)
5. Milia – tiny white bumps on the nose and cheeks (present at birth)

Herpes Simplex: Serious Newborn Rash

• Appearance. Several water blisters or pimples grouped in a cluster. They look like the cold sores (fever blisters) that adults get on their lip. After several days, they crust over.
• Location. Just one part of the body, usually the scalp or face.
• Redness. The base can be pink. The pinkness does not extend beyond the cluster of vesicles.
• Onset. Within the first 2 weeks of life.
• Importance. Early treatment with anti-viral drugs can prevent serious complications. If you think your newborn’s rash looks like herpes, call your child’s doctor now.
• Imitator. Although herpes can be confused with erythema toxicum, they look very different.

Care Advice

1. Acne:
   • More than 30 percent of newborns develop baby acne of the face. Acne consists of small red bumps.
   • This baby acne begins at 3 or 4 weeks of age. It lasts until 4 to 6 months of age.
   • The cause appears to be the transfer of maternal hormones just prior to birth.
   • Since it goes away on its own, no treatment is needed. Baby oil or ointments make it worse.
2. Drooling or Spit-up Rash:
   • Many babies have a rash on the chin or cheeks that comes and goes. This is often due to contact with food. It can also be from acid that has been spit up from the stomach. Prolonged contact with spitup during sleep can cause the rash to get worse.
   • Other temporary rashes on the face are heat rashes. These can occur in areas held against the mother’s skin during nursing. Heat rashes are more common in the summertime.
   • Rinse the face with water after all feedings or spitting up. Do not use soap on the rash. Reason: Soaps can slow healing.
   • Heat rash also can cause a rash on the face. During hot weather, change the baby’s position more often. Also, put a cool washcloth on the rash. 3.
3. Erythema Toxicum:
   • More than 50 percent of babies get a rash called erythema toxicum. It starts on the second or third day of life.
   • It’s a harmless baby rash that doesn’t need to be seen.
   • The rash is made up red blotches. They are ½ inch to 1 inch (1 to 2.5 cm). The blotches have a small white or yellow "pimple" in the center.
   • They look like insect bites, but are not. Red blotches are the main feature.
   • They can be numerous, keep occurring, and look terrible. They can occur anywhere on the body surface, except the palms and soles.
   • Their cause is unknown, but they are not an infection.
   • They go away by 2 weeks of age.
4. Forceps or Birth Canal Injury:
   • The pressure of a forceps on the skin can leave marks. You may see bruises or scrapes anywhere on the head or face.
   • During birth, skin overlying bony prominences can become damaged. You might see this on the sides of the skull bone. This is from pressure from the birth canal. Even without a forceps delivery, you may see bruises or scrapes.
   • Fetal monitors can also cause scrapes and scabs on the scalp.
   • The bruises and scrapes will be noted on day 1 or day 2. They go away by 1 to 2 weeks.
   • A fat tissue injury won’t appear until day 5 to 10. Look for a firm coin-shaped lump. It will be under the skin and sometimes with a scab. This lump may take 3 or 4 weeks to go away.
   • For any breaks in the skin, apply an antibiotic ointment. An example is Polysporin. No prescription is needed. Use 3 times per day until healed.
   • Call Your Doctor If:
   • It becomes tender to the touch
   • Becomes soft in the center
   • Starts to looks infected
5. Milia:
   • Milia are tiny white bumps that occur on the face. Milia occur in 40 percent of newborn babies.
   • The nose and cheeks are most often involved. Milia can also be seen on the forehead and chin.
   • Milia are many in number. They occur equally on both sides of the face.
   • Although they look like pimples, they are much smaller (pinhead size). They are not infected.
   • They do not look like water blisters.
   • They are blocked-off skin pores. They will open up.
   • Milia will go away by 1 to 2 months of age.
   • No treatment is needed. Ointments or creams can make them worse.

Call Your Doctor If

• Rash starts to look infected
• Your baby starts looking or acting sick
• Your baby starts looking or acting abnormal in any way
• You think your baby needs to be seen

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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