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Archive for January 11th, 2010

Spotty babies

There you are, proud new parents of a tiny, pink little person and just as you are ready to show your beautiful creation to the world baby’s skin erupts, and or peels off. Everyone has heard of milia, or milk spots, which babies may be born with or develop soon after birth and may last several weeks. They are tiny and are generally clustered on and around baby’s nose. They are just where the tiny glands which lubricate the skin are just not flowing freely yet so tiny cysts form and as the name implies they are creamy-white. Leave them alone apart from normal, gentle cleansing with plain water.

Another really common rash a baby may develop is urticaria neonatorum or erythema toxicum, parents will often see this noted by the person who examines baby and it can occur anywhere on the baby. Sounds impressive but is really nothing to worry about. It looks a bit like a heat rash, a few little red spots clustered together, and often this is what professionals will call it when reassuring Mums and Dads. Sometimes the spots do have very small yellow heads on them, they are not infected though and are totally harmless. They do disappear very quickly, only to reappear somewhere else, so often I will visit and the parents will ask me to check the spots out, only to discover that they have gone or magically moved! We have no idea why some babies get it and some don’t. I have my own theory, baby has been wallowing around in a sterile, fluid environment with nothing irritating it’s skin but once born it has different materials rubbing its skin; the skin is exposed to chemicals from washing powders and parents toiletries plus all the tiny fibres and hairs in the environment and the baby is now having to compensate for rapidly changing temperatures. Just my thoughts but worth taking in to consideration when chosing washing powders,  fabric conditioners and deciding whether or not you should use that cream or those baby wipes for your little one. Anyway, it’s usually quite a short-lived rash, generally appearing within a couple of days lasting to 10 days after birth.

Neonatal acne, much like the teenage version. Looks horrid, lots of red pimples, sometimes all over baby’s face but most common on his/her forehead and cheeks. It usually shows up just as you are really starting to socialise, when baby is around 1 – 3 months old and it can last for weeks. It usually requires no treatment, just use clean water and no prodding or squeezing! If too much attention is paid to these angry looking eruptions then, the same as in older people, scarring may occur.

Neonatal acne

On the whole the advice regarding spots is ‘ Don’t worry’ BUT if your baby has spots AND appears unwell, is overly sleepy and not feeding well please contact your G.P as s/he may have an infection.

A doctor specialising in skin disorders has corrected me on some details in this entry so I’m posting his comment here –

MWM, I am a bit confused by your comments. I am a 2 yr qualified GP undertaking advanced dermatology with Cardiff University. May I explore some themes with you?

Firstly, I have discovered that milk spots and milia and are actually not the same thing.

Milk spots are simply areas of sebaceous gland hyperplasia (or enlargement..for any other readers) which appear in the neonate (<4 week old…) and apparently generally go after a few weeks. They are white-yellow in appearance. The enlargement is thought to be related to maternal androgens transferred to babies, hence the term ‘milk spots’. They classically appear on the nose and forehead.

Milia on the other hand are only white, up to 2mm in size and are due to keratin (skin’s epidermis cells) cysts (fluid sacks). Seen in up to 50% of neonates. Usually rupture within 2 months of birth. Also appear on the face/forehead.

You say neonatal acne (or acne neonatorum) occurs between 1-3 months of age. Where does this info come from? Literature states it develops between the 3-6 months. I have yet to see it myself. At a glance, I am not convinced that your picture actually is acne..it looks more like sebaceous gland hyperplasia to me. Worth showing a dermatologist to confirm?

So what has Marsi’s baby got? I do not diagnose over the net as a disclaimer to all readers. It maybe mildy inflammed milk spots that probably do not need much at all but a full history and examnation is required by her GP firstly. A differential could be the papules (spots) of erythema toxicum which up to 50% of babies get some form of in the first 12m. The baby should be seen by the GP to exclude septic pustulosis if mum says it is nasty. Incidentally Marsi could be worrying unnecessarily here about neonatal acne perhaps?? Unlikely at 1m old apparently.

If there is one thing I have relearned about dermatology is that there is no replacement for actually seeing the lesion in the flesh. I guess we all need to carefully validate what we write for patients on the old ‘net so that we are firstly safe and secondly do not overworry mum’s.

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