1. Baby Rashes
1. The baby's skin
2. Common skin problems
3. How to treat and prevent
4. Cases

2. -non living
-replace every month
- receptors
(touch , heat, pain, pressure
- starts to mature at 1st w OL.
will continue to
mature 6 months postnatal life
- protection from trauma
-heat storage
-conserve calorie

3. B : skin epidermis is 1-2mm
A : 2-3mm
Thinner
-absorb and hold watter better
-fast water loss
- temperature
-microorganiss
-humidity
-external irritants
- temperature
-microorganiss
-humidity
-external irritants
-sweat gland not fully develop
(not able to fully
regulate temperature)
Not fully develop
- 13% of body weight of neonate
-3% of body weight in adult
High body to surface area
1/6 of adult
PH 5.5
- more sensitive to infection
and irritation
-Preterm infants have less collagen and elastin fibers in the dermis and are thus prone to edema.
-Components of the dermal extracellular matrix in combination with the fetal environment and
inflammatory response permit healing of skin wounds without scarring. This was first noted by surgeons
involved in experimental fetal surgery.
(Cohen & Siegfried, 2005; Dostal & Gamelli, 1993; Houska-Lund & Durand, 2006; Lund et al., 1999; Witt, 2004)

4. Infant Vs Adult
1. structure
- immaturity/ thinner/less hairy /less firm
2. composition
- relative high body surface area,
elevated transepidermal water loss,
protective flora is absent
3. function
- predispose to greater heat and fluid
loss + drug / toxin absorption

5. When u see a skin rash....
- Characteristic of lesions / types
(?papular/ macular? Vesicular? Red?
Demarcation line?
**m-p-v is primary lesion
**scaling is 2dry lesion
- Location, Distribution and progression
- Timing of onset in relation to nonspecific
sx

6. Common skin lesions
- Macule: nonpalpable, circumscribed, flat lesion (<1 cm in diameter)
- Papule: palpable , elevated lesion (<1 cm in diameter)
- Maculopapular: combination of macular and popular lesions
- Purpura: non-blanching papules or macules due to extravasation of
RBCs
- Vesicle: fluid-filled, elevated skin lesion (<1 cm in diameter)
- Bulla: fluid-filled, elevated skin lesion (>1 cm in diameter)
- Pustule: pus-containing vesicle
- Ulcer: depressed skin lesion with missing epidermis and upper layer
of dermis

8. Skin irritation ++
Candidiasis –very red with small red bumps
(sometime pus filled)
on outer edge
require Rx antifungal cream
1. clean + atmosphere
2. hydration ! Hydration ! Mouisterizer !!
Heat rash!
(miliaria rubra)

10. Why heat rash happened?
- Blockage of the pores that lead to the sweat
glands / sweat retention cause by partial
closure of the gland.
- It is most common in very young children
but can occur at any age, particularly in hot
and humid weather.
- An infant does not sweat. **immaturity of
skin structure.
- The sweat is held within the skin and forms
little red bumps or occasionally small blisters.
RX – cooling the room and moisturizer!!

12. Erythema Toxicum Neonatarum
- Etiology : unknown
- Most common pustular eruptions, macules &
papules evolve into pustules, not involving palms and
soles
- Resembles Musquiote bites????
- Flat red splotches (usually with a white, pimple-like
bump in the middle)
-This rash rarely appears after 5 days of age, is
usually gone in 7 - 14 days / Rx – not needed.

13. Resembles eczema but it does not itch!!
-scaly/crusted/flay
Appears at first 3mo
Sharpyly demarcated
Brightly erythematous
Papulasqumous disorder
Overactivity of the sebaceous gland
(producing sebum)

14. Seborrheic dermatitis
Ddx
1. Eczema – red with
scales
2. Impetigo – infected
plaques+itchy
3. nappy rash/ candidiasis
– location (perianal/groin)
4. psoriasis ? Similar ,
can look similar
in babies
5.Fungal infections
- eg, tinea
Rx
1. conservative
(tar containing shampoo/ petrolatum/ soft brush)
3.( may require aq cream/ steroid cr)

16. Eczema
-Irritation of the skin
-Dry, scaly, red (or darker than normal skin
color), and itchy++
-When it goes on for a long time the areas
become thickened.
- Often associated with asthma and allergies,
although it can often occur without either of
these.
- Eczema often runs in families
- Rx ; steroid cream / tacrolimus (calcineurin
inhibitors and work by modulating the
immune response)

18. Acne Neonatarum
-?? result from stimulation of sebaceous
glands by maternal or infant androgens
- resolve in 4-6 months
- not requiring any topical rx
- in some severe cases, may require topical
benzyl peroxide

20. Observe and see!
1. Is the rash red and scaly or red and non
scaly?
2. Are there pustules or blisters? Pus
discharge?
3. Is it a funny shape, colour or distribution?

21. Chicken Pox ( Varicella)
1.Etiology : Varicella Zoster
2. MOT : Airborne / contact
3. Site : Face / scalp to trunkal
4. Stages : contact - > *
contagious ( 2-3 up to 5 days
before rash(m-p-v appears) *dew
drops on rose petal appearance*→
no more contagious when rash
dry/ crusted
6. incubation period 10-21days
7. rx – 1)hydration
2) analgesia
3) cream/lotion

22. Measles ( Rubeola)
Etiology ; rubeola virus
MOT : airborne
- droplets ( active for 2 hours on
air) → incubation period 8-10d
→ >sx shows
*fever/cough/corya/conjuctivit
is → 3-4d rash appears
**blanching erythematous
maculopapular
**begins in head/neck and
spreads centrifugally

23. Rubella
● Etiology – Rubella Virus
● MOT - contact/airborne
● Uncommon now – MMR
vaccine
● Characteristic of 3days
illness/rash dissapears
● Ddx measles
● sub occipital & posterior
cervical
lymphadenopathy

24. Hand Foot Mouth Disease
● Etiology : Enterovirus genus
( Picornaviridae family)
(Coxsackie V A16 or
Enterovirus 71 ; rare
complications eg meningitis)
● Stages – nonspe sx eg
fever/LOA/sorethroat → 2-3d--
> rash appears ( macula-papular
develops into vesicular)
● Rx – symptomatic , analgesia +
mouth wash

25. Reassurance!!!
1. Use gentle, fragrance-free cleansers and soaps.
Minimise usage of topical toxin and drugs
2. Always moisturize
3. Skin irritation / allergic reactions -> zinc oxide or titanium
dioxide
4. Wear protective clothing, such as a long-sleeved shirt,
pants, a wide-brimmed hat and sunglasses, where possible.
5. sunscreen! ( not recommended for < 6mo – try to avoid the
sun!)
6. consider bact/virus/fungal if present pustule/vesicular
7. take ixs ( helpful! ) , smears and fluid culture