Common Newborn Rashes and What They Mean

A newborn's skin goes through a lot of changes in the first weeks. Bumps, blotches and spots show up, move around and fade, often all in the same week. Most of these rashes are harmless and clear on their own without any cream or treatment. A few, though, can be a sign of illness. This guide helps you tell the common, harmless rashes apart from the ones that need a call.

Common harmless newborn rashes

Erythema toxicum

Despite the scary name, this is one of the most common rashes in healthy newborns. It looks like red blotches with small yellow or white bumps in the center, a bit like flea bites. It often appears in the first few days of life, mostly on the chest, back, face, arms and thighs. Spots can fade in one place and pop up in another within hours. Your baby will act completely normal. No treatment is needed, and it usually clears within a couple of weeks. MedlinePlus has a short summary of erythema toxicum.

Milia

These are tiny, hard, pearly white dots, usually on the nose, chin and cheeks. They are small bumps of trapped skin protein. Similar white spots can show up on the gums or roof of the mouth. Milia do not hurt, and they go away on their own over the first weeks to months. Do not squeeze or scrub them.

Baby acne

Small red or white pimples on the cheeks, nose and forehead often appear at a few weeks of age. They may look worse when your baby is warm, fussy or after spit-up rubs on the skin. Hormones from pregnancy likely play a role. Wash the face gently with plain water once a day, pat dry, and skip lotions, oils and adult acne products. Baby acne usually fades over several weeks to a few months.

Heat rash

Heat rash shows up as tiny red or clear bumps in places where sweat gets trapped: the neck, armpits, chest, upper back and diaper area. It happens when a baby is dressed too warmly or in hot, humid weather, which is common in San Antonio for much of the year. To help:

• Dress your baby in light, loose cotton clothing.
• Keep the room comfortably cool and avoid bundling.
• Let the skin air out, and give a lukewarm bath if needed.
• Avoid thick creams on the area, which can trap more heat.

Heat rash usually improves within a few days once your baby cools down.

Other skin changes you may notice

• Peeling skin in the first week or two, especially on hands and feet, is normal, especially in babies born after their due date.
• Blotchy, lacy skin when your baby is cool is from blood vessels near the surface and goes away when they warm up.
• Stork bites and angel kisses are flat pink patches on the back of the neck, eyelids or forehead. Many fade over time.
• Bluish-gray birthmarks on the lower back or buttocks are common in babies with darker skin. They are harmless and should be noted in your baby's chart so they are not mistaken for bruises.
• Diaper rash is common and usually responds to frequent changes and a barrier cream.

Gentle skin care for any rash

• Use plain water or a mild, fragrance-free baby cleanser.
• Pat skin dry instead of rubbing.
• Wash your baby's clothes and bedding in a fragrance-free detergent.
• Do not put adult creams, steroid creams or home remedies on a newborn's skin unless your pediatrician advises it.
• Keep nails short to prevent scratching.

Rashes that need a call

Some rashes are a warning sign, especially when a baby also seems sick. Call your pediatrician the same day, or right away, if you see:

• Any rash with fever. In a baby under 3 months, a temperature of 100.4°F or higher needs a call right away, rash or not.
• Tiny red, purple or brown dots that do not fade when you press on them, or bruise-like patches. These can be a sign of bleeding under the skin or a serious infection.
• Blisters, pus-filled bumps or crusted sores, especially in clusters, or around the umbilical cord or diaper area. Blisters in a newborn can be from infections, including herpes, that need prompt treatment.
• Yellow color of the skin or eyes that is spreading or deepening. Jaundice is common but needs to be checked.
• Red, warm, swollen skin that is spreading, or redness around the cord stump.
• A rash along with poor feeding, unusual sleepiness, vomiting, or fewer wet diapers.
• A rash that seems itchy or painful, oozes, or keeps getting worse.

A helpful trick: take a clear photo of the rash in good light. Rashes come and go, and a photo can help your pediatrician see what it looked like at its worst.

When to call us

Call your A thru Z Pediatrics office if your baby has any of the warning signs above, if a rash is not improving after a week or two, or if you simply are not sure what you are seeing. Newborn rashes are one of the most common questions parents ask, and there is no such thing as a silly call.

Call 911 or go to the nearest emergency room if your baby has a rash with trouble breathing, swelling of the face or lips, is limp or very hard to wake, or has a fast-spreading purple rash and seems ill. For a rash that is not urgent, request a visit. You can find more general health information at MedlinePlus.