POST TIME: 3 September, 2018 00:00 00 AM
Skin diseases in neonates
Dr Wrishi Raphael

Skin diseases in neonates

Mothers get worked up by rashes in the newborn and rightly so; the fear that these unsightly scars may result from some infection, serious underlying disease or may scar the child’s skin for ever is justified and warrants a more detailed idea of the types, duration and intensity of various rashes of the newborn.

Nappy Rash

Causes of nappy rash are given below:

The main predisposing factor in all types is dampness due to urine and faeces. It is far less common since the use of disposable nappies. Other causes or aggravating factors are:

A tendency of the baby to eczema (a skin disease which causes skin irritation and closely linked to allergic reactions)

A tendency of the baby to Candida (thrush) infection

Rough-textured nappies, detergents and other chemicals in nappies

Plastic pants (aggravates wetness)

Excessive washing of the skin with soap

Too much powder over the nappy area (better to apply talcum powders in lesser amount)

Uncommon causes

The psoriatic nappy rash presents as a non-scaling eruption, primarily on the napkin area, but can extend to the trunk and limbs. The edge of the rash is sharply demarcated.

The typical psoriatic scale is absent. It tends to occur in the first weeks of life. There is usually a family history.


Bacterial infections to consider include staphylococcal folliculitis, (infection of root of hair or follicle) impetigo and perianal (around the baby’s bum) streptococcal dermatitis. Culture of the lesion will reveal the cause.


If there is Staphylococcus infection, bullae (fluid filled lesions) and pus-filled blisters will be present.

Histiocytosis X (Letterer-Siwe syndrome)

There is a similar rash to seborrhoeic dermatitis (a form of skin infection which may occur in infants and adults around areas where there is more secretion of sebum a naturally occurring oily substance which keep our skin moisturized) but the lesions are itchy.

In this serious syndrome the child is very ill and lymphadenopathy (abnormal size and consistency of lymph nodes) and hepatosplenomegaly (increased size of liver and spleen) may be found.

Zinc deficiency. It may be more common than realized.


Basic care (instructions to caregivers):

Keep the area dry. Change wet or soiled nappies frequently and as soon as you notice them. Disposable nappies are helpful.

After changing, gently remove any urine or moisture with diluted sorbolene (or any other oil based ointment) cream or warm water.

Wash gently with warm water, pat dry (do not rub) and then apply any prescribed cream or ointment to help heal and protect the area. Vaseline or zinc cream applied lightly will do.

Expose the bare skin to fresh air wherever possible. Leave the nappy off several times a day, especially if the rash is severe.

Do not wash in soap or bathe too often-once or twice a week is enough.

Avoid powder and plastic pants.

Use special soft nappy liners that help protect the sensitive skin.

Thoroughly rinse out any bleach or disinfectants.

Medical treatment

Some principles follow:

The cornerstone of treatment is prevention.

Emollients should be used to keep skin


( e.g. a mixture of zinc oxide and castor oil or Vaseline).

A mild topical corticosteroid is the treatment of choice.

It is usual to add an antifungal agent.

General Practitioners are requested to be careful of excessive use of corticosteroids.

If infection is suspected, confirm by swab or skin scraping.