Many new parents become alarmed by the sudden appearance of a rash on their baby’s face. With so many possible underlying conditions, it is hard not to worry. Rashes are quite common, though, and, most of the time, they are no cause for concern. The most common skin disorders appear seemingly at random and disappear without treatment. However, some bumps and spots are signs that your little one needs a doctor’s help.

Erythema Toxicum Neonatorum

Erythema toxicum neonatorum is the most common rash in healthy newborns, affecting about 50%. This benign condition develops as reddish blotches ranging from 1 to 3 centimeters in diameter, with tiny blisters or clear sacs in the middle. A baby may have just one or two, or hundreds of these spots. This noninfectious rash can turn up on the face and limbs but primarily appears on the trunk. It typically emerges at one or two days old but sometimes flares up around the fourth day. The little blisters do not seem to irritate infants, and they clear up spontaneously within three to seven days.

Miliaria Pustulosa

Miliaria pustulosa is a skin condition marked by clusters of pus-filled sacs on the forehead, neck, upper back, and limbs. It arises from the obstruction of sweat glands due to a warm, humid environment, excessive clothing, or undeveloped sweat pores. Miliaria pustulosa is not the result of an infection. However, the lesions can get infected and become itchy. A pediatrician may recommend antihistamines and calamine lotion or another topical soothing agent.

Baby Acne

About one in five newborns has neonatal acne, which can manifest any time from birth to six weeks. The breakouts usually appear on the nose, cheeks, forehead, chin, scalp, neck, back, and chest. This minor condition rarely causes scarring and typically goes away on its own within a few weeks or months. If your infant develops acne after six weeks of age, consult a dermatologist to determine the cause and appropriate treatment. Dermatologists advise:

• Not applying acne products to the baby’s skin unless recommended by a pediatrician or dermatologist.
• Gently washing the baby’s skin with tepid water and avoiding scrubbing.
• Discontinuing the use of greasy or oily skincare products.

Eosinophilic Pustulosis

Eosinophilic pustulosis, also called eosinophilic pustular folliculitis, causes recurrent crops of itchy, ring-shaped lesions on the face, scalp, trunk, and extremities. It appears within the first six months of life, with about 25% of occurrences at or just after birth. The rash goes through a crusting phase for five to ten days, resolving spontaneously without scars. The lesions can reappear every two to eight weeks. A doctor may prescribe antihistamines and topical steroids to soothe itchiness.

Transient Neonatal Cephalic Pustulosis

Transient neonatal cephalic pustulosis can appear in the first three weeks of life. Reddish blisters are surrounded by a reddish halo on the eyelids, cheeks, chin, neck, and upper torso of a healthy newborn. This rash does not usually require treatment and heals without scarring within three months. If it persists, a topical antifungal may help.

Hives

Hives or urticaria are red, raised welts or bumps on the skin. They can appear anywhere on the body as tiny spots, blotches, or larger, connected bumps. Individual spots last from a few hours to several days, and new ones often replace those that go away. Acute hives stay for six weeks or less; chronic hives persist longer than six weeks. The bumps develop from an allergic reaction to certain foods, medicines, pets, insect bites, or pollen. Breakouts may also result from viral infections, sun exposure, or contact with chemicals. Often, doctors cannot pinpoint the cause. Treatment is usually unnecessary, but the physician may prescribe an antihistamine or steroid in severe cases.

Eczema

Eczema is an umbrella term for a group of chronic conditions that cause skin inflammation, redness, and itchiness. Common types that affect young children include atopic dermatitis, contact dermatitis, and seborrheic dermatitis or cradle cap. Eczema, particularly atopic dermatitis, often develops in the first six months to five years. Research indicates that eczema arises from a combination of genetic factors and environmental triggers. It appears to run in families but is not contagious. There is no cure; treatments for symptoms include topical medications, phototherapy, immunosuppressants, and avoiding triggers.

Roseola Infantum

Children who develop roseola infantum are between six and 36 months of age. This infection is caused by human herpesvirus-6 and occurs most often in the spring and fall, but it can arise at any time. Symptoms include sudden high fever and a rash that appears within a few hours of the fever breaking. The red, flat rash presents primarily on the chest and abdomen but also can show up on the face, arms, and legs. Although the fever may be treated, the non-irritating rash doesn’t require treatment, lasting from a few hours to a few days before resolving on its own.

Chickenpox

The varicella-zoster virus causes chickenpox, an itchy rash with small, fluid-filled macules. The blisters present 10 to 21 days after exposure to the virus. Other symptoms include fever, headache, loss of appetite, and lethargy. The highly contagious rash goes through three phases: raised red bumps, small fluid-filled blisters, and crusts and scabs. It is typically mild in healthy children. If a parent suspects their baby, particularly one under six months old, has developed the chickenpox, it is best to consult a doctor.

When to Seek Immediate Care

If your baby has a rash on their face and is very weak or not moving, call 911 immediately. A baby less than one month of age looking or acting abnormally with a troubling skin condition needs medical attention. Reach out for help if the baby is less than 12 weeks old with a fever. Contact a healthcare provider if you see blood-colored dots or spots that were not present at birth. If the rash is painful or the baby’s skin looks infected with spreading sores, pus, or redness, they need care urgently.