Newborn Rashes and Birthmarks

Definition

Common questions asked about normal skin rashes and normal birthmarks in newborns

Topics Covered

If your baby is healthy, skip the "When to Call Your Doctor" section. Go directly to the topic number that relates to your question for advice.

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.

Age under 1 month old and looks or acts abnormal in any way
Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen.)
True blisters (little bumps that contain clear fluid)
True pimples (little bumps that contain pus). (Exception: looks like erythema toxicum which occurs in half of newborns)
Skin looks infected (such as spreading redness)
Rash is painful to the touch
You think your child needs to be seen urgently

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 to 5 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.

Drooling 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. During hot weather, change the baby's position more often. Also, put a cool washcloth on the rash.

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.
No treatment is needed. Ointments or baby oil make it worse.

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

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.

Mongolian Spots:

A Mongolian spot is a normal bluish-green or bluish-gray flat birthmark. They occur in over 90 percent of Native American, Asian, Hispanic, and African American babies. They are also seen in 10 percent of Caucasians, especially those of Mediterranean descent.
They occur most commonly over the back and buttocks. However, they can be present on any part of the body.
They vary greatly in size and shape.
They do not indicate illness or any disease.
Most fade away by 2 or 3 years of age. A trace may persist into adult life.

Stork Bites (Pink Birthmarks):

Flat pink birthmarks that occur over the bridge of the nose or the eyelids. You can also find them on the back of the neck ("stork bites"). They occur in more than 50 percent of newborns. The ones in front are often referred to as "an angel's kiss".
All the birthmarks on the bridge of the nose and eyelids clear completely. Those on the eyelids clear by 1 year of age. Those on the bridge of the nose may persist for a few more years. Those on the forehead from the nose up to the hairline usually persist into adulthood. Laser treatment during infancy should be considered. Most birthmarks on the nape of the neck also clear. But, 25 percent can persist into adult life.

Strawberry Hemangiomas:

Strawberry hemangiomas are red birthmarks that are raised or increasing in size. These usually start after 3 weeks of age.
They become larger for 1 year. Then, they fade away over 6 to 8 years without any treatment.
They run a small risk of bleeding with trauma. Any bleeding should stop with 10 minutes of direct pressure.
Discuss with your child's doctor on the next regular visit. Call sooner if you are concerned.

Port-Wine Stain Birthmarks:

Call Your Doctor If:

Capillary Hemangioma - Neck and Posterior Scalp

Strawberry Hemangioma - Forehead

Erythema Toxicum

Mongolian Spot - Buttocks

Strawberry Hemangioma - Abdomen

Author and Senior Reviewer: Barton D. Schmitt, M.D.