Dear Dr. Lanny:
My 3-year-old godson just received a diagnosis of ringworm. I am pregnant with my first child. Do I need to avoid my godson? Is ringworm a worm? How do you catch it? Can you tell me how keep all the various rashes straight when my baby is born; I want to know what to watch out for.
A: You would think that we all know what is meant when someone says that a child has a rash. Surprisingly, the word means different things to different people. For example, to some parents, it is only a rash if it is red or raised. So, let’s start by defining the term: A rash is any change in the skin which affects its appearance, color or texture.
I’ll return to the question of common newborn rashes, but first I’d like to briefly discuss ringworm. In the pantheon of plagues affecting daycare or school attendance, ringworm is only surpassed by fever or the dreaded “pinkeye.” And no, ringworm is not a worm. It’s even creepier: It’s a fungus. Creepy as it may be, ringworm is just a very superficial infection that is easily treated with relatively inexpensive over-the-counter topical (placed on the skin) medication.
Ringworm tends to be circular or oval, has a very distinct slightly raised border, and a clearer but scaly center. It is easily confused with areas of eczema, which tend to have a less distinct border and no central clearing. Ringworm tends to be more common in the summer months due to heat and sweat. Eczema tends to be more in the winter months when heating systems cause our homes to be drier than the desert. Once ringworm is being treated, and is covered by clothing or Band-Aids, there is no danger to fellow students or newborn babies.
Newborn rashes could take up a book, let alone a single column, so for practical purposes, I’ll just touch on several common problems.
In the first days of life, the newborn’s skin may turn a yellow color (jaundice). This is a very common occurrence and usually does not require any testing or treatment. Occasionally blood samples may need to be tested and, less frequently, treatment given, in the form of several special lights shined on the baby’s naked skin. Children who are premature or ill are of greater concern when evaluating jaundice and may be treated earlier than would a full-term healthy infant. Treated or not, jaundice tends to be a brief concern generally resolving within a week or two.
Occasionally newborns may show one of two tongue-twister type rashes, each whose name is much worse than the rash itself. Erythema toxicum is characterized by small white or yellow bumps surrounded by an erythematous (red) ring. These lesions may be seen on the face or the body and can be quite impressive. They will quickly disappear and are totally harmless.
If you have relatives or friends you are trying to avoid, tell them your newborn has transient pustular melanosis. That will scare them off. This is another very early and harmless rash, also characterized by very small pustules (bumps with pus-like matter in them) that break easily and leave a small freckle-like brown spot.
Milia are even smaller white bumps, typically seen in substantial numbers across the nose and on the cheeks. Again, a harmless and transient condition.
One last, yet again harmless, but often worrisome appearing facial rash is newborn acne. These infants appear to have a bad case of adolescent acne, principally on the forehead and cheeks. It differs in appearance from the rashes discussed above in that it looks worse, appears in varying stages across the face, and tends to last much longer—months rather than days. Its cause is unknown but may relate to maternal hormones. As unpleasant as it may appear, it is usually self-limited and will fade within a few months. Thank goodness for Photoshop.
But enough about facial rashes. Let’s talk a little bit about the other end. Diaper rashes are usually caused by an irritant or yeast. Babies’ skin is a wonderful barrier against bacteria, yeast and irritants, but constant exposure to the warmth and moisture of diapers can break down this barrier and allow rashes to develop.
Redness, particularly on the backside, is likely to represent skin breakdown from stool, or possibly soap or other cleansers. In general, frequent diaper changes, cleaning with warm water and thorough drying will minimize or totally prevent backside rashes. Soap may clean your baby’s backside, but it also removes the protective oil the skin produces. Keep soap to a minimum.
A very nasty-looking red diaper rash mostly in the front, and particularly deep down into the area where the leg and the body come together is likely to be a yeast infection. Yeast infections often look as though they should be very painful, but they don’t seem to bother the baby. When a parent calls and says that baby Bubba has a terrible rash, and they’ve tried everything—which usually means diaper creams such as A&D, Desitin and Vaseline—it’s almost surely yeast. It is easily treated with water, thorough drying and anti-yeast medication.
In the first weeks of life you will see the doctor in the hospital, and then in the office at about 1 and 3 weeks of age. If your baby is otherwise well, and is eating well, you can safely wait for any of those visits to discuss the rash.
Dr. Alan Freshman, father of two grown sons, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at firstname.lastname@example.org.