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DermNet NZ


Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Skin conditions affecting newborn babies

Introduction

A large number of conditions can cause vesicles (small blisters), pustules (yellow blisters), bullae (big blisters), erosions (sores) and ulcerations during the newborn period. The most common are toxic erythema of the newborn (also known as ‘erythema toxicum neonatorum’) and miliaria. Other conditions to consider include:

Toxic erythema of newborn

The eruption known as toxic erythema of the newborn affects 50% of full-term neonates but is uncommon in premature babies. It arises in the first few days and presents with scattered pink or red marks often with papules (small bumps), pustules and wheals scattered over face and the rest of the body. The lesions are transient. Toxic erythema spares the palms and soles. It does not bother the baby. It resolves spontaneously over one to two days.

If investigations are thought necesssary, microscopy of a pustule may show eosinophils (a type of white blood cell). In contrast, neutrophils (another type of white blood cell) are characteristic of transient neonatal pustular melanosis, which only affects dark skinned babies. It may be appropriate to culture the lesions for bacteria, candida and herpes virus.

Toxic erythema of the newborn Toxic erythema of the newborn Toxic erythema of the newborn
Toxic erythema of the newborn

Miliaria

Miliaria affects about 15% of newborn babies in warm climates and is due to blockage (occlusion) of the sweat duct. If the occlusion is superficial, sweat collects just below the stratum corneum (dead cells on skin surface) forming clear, thin-walled blisters (miliaria cristallina). Slightly deeper occlusion results in red papules and pustules (miliaria rubra or ‘prickly heat’).

Miliaria most often affects the forehead, neck and upper trunk and occluded areas of babies in the first few weeks of life. It settles within a few days on cooling and removing occlusive clothing.

Milia

Milia are tiny white spots. They are blocked pores. About 50% of infants have milia on the face, most resolving within the first 4 weeks of life. Milia in newborns may also occur on the hard palate (Bohn's nodules) or on the gum margins (Epstein's pearls). These also resolve spontaneously.

Milia Milia
Milia

Sucking and suckling blisters

Sucking blisters are caused by vigorous sucking by the infant whilst still in the womb. Intact blisters or erosions may be found on the forearm, wrist, hands or fingers. They resolve within a few days.

Suckling ‘blisters’ are firm swellings on the upper lip and are a hyperplastic response to suckling.

Related information

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Author: Dr Amanda Oakley, Hamilton, New Zealand.

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.