A rash is eruptions of red spots or patches on the skin and
is a sign of an underlying problem caused by reactions to substances, allergies
or infections. Knowing the different types of rash and treatment is important
to help alleviate your baby's discomfort.
 Cradle cap is a condition whereby
patches of greasy yellow flakes and small pimple-like bumps appear on the
scalps of healthy babies. Sometimes
it may appear on the eyebrows, ears and other areas where sebaceous glands are
located. It can occur in any baby,
and appear during the early weeks of life and will clear by the sixth month.
Some dermatologists think that high levels of maternal hormones are transmitted
to the baby during the final weeks of pregnancy. This makes the sebaceous (oil)
glands in the baby's skin hyperactive which trigger overproduction of sebum
which not only overstimulates the growth of new skin cells but also binds the old
skin cells into flakes and crusts. It often has a mild unpleasant smell and does
not cause any discomfort to the baby.
Some doctors recommend leaving it alone but I prefer to
treat it early because I have seen many cases whereby the crust becomes so
thick that whenever it is rubbed, large
chunks of hair comes off leaving a very red and raw looking area. Treatment is
to apply a liberal amount of baby oil to the affected area about 20 minutes
before the baby's bath. This will allow the crust to become soft and easy to
remove. During the bath, apply a little baby shampoo to the head and using a
soft hair brush or face cloth, gently brush or rub the crust off. Do this once
a day until the crust has been completely removed. Sometimes it may recur after
a few days so continue to wash baby's hair in the same way. Once the baby's sebaceous
(oil) glands settle down the condition will disappear.
N.B. The oil application must
be shampooed out to prevent an oily buildup which may make the condition worse.
Do not try and remove the crusts and scales with the tip of a fingernail.
 Heat rash consists of tiny
blisters filled with sweat. It forms when the pores become blocked and prevent
the sweat glands from releasing the sweat or when heat and humidity exceed the
ability of the sweat glands to cool the body. Babies are especially vulnerable
because their ability to sweat is not fully developed and they often wear or
lie on waterproof materials. It normally develops around the neck, face,
armpits and sometimes on the chest and back.
Western medication includes applying calamine lotion and
antihistamines for severe itching. Sometimes applying a light dusting of corn
starch powder may help to relieve the itchiness. Chinese traditional remedy is
to bath the baby with boiled dried bitter gourd vine daily for 3 days.
It is best to prevent the condition from developing by
dressing the baby in light cotton clothes especially in warm or hot weather.
Avoid laying the baby on a plastic covered mattress or pad. Do not apply
moisturizing cream or lotions or use bath oils for babies under 3 months as
these products may clog the pores. Do not over wrap the baby in layers of
clothes and swaddling blanket.
 Nappy rash is often due to
infrequent nappy change causing irritation from ammonia which is released when
bacteria starts breaking down the contents of a dirty nappy. It could be due to
an allergy to your washing powder or fabric conditioner if your baby wears
cloth diapers or a food/drug allergy especially antibiotics. The genital area, buttocks, groins and sometimes the
upper thighs will look red and inflamed. It can be dry or moist and sometimes
look pimply. Babies with nappy rash may be very fussy and cries frequently or
does not seem bothered at all.
"Prevention
is better than treatment" so the best defence against nappy rash is a dry
bottom.
 Infantile eczema is an itchy dry
scaly rash usually seen on the cheeks or chin, but may show up on the head,
trunk, back of arms, or front of legs and is not contagious. It is first
noticed at 2 to 5 months of age and is most common in families with history of
allergies or asthma. In most cases it will settle down by the time the child
reaches school age but for some it may continue to be a life long problem. The
frequency and severity of flare ups can be dramatically reduced with careful
daily washing using a hypoallergenic soap and applying moisturisers, topical
steroids when needed. Avoid trigger factors such as excessive sweating, woollen
clothing, soaps and bubble bath. Sometimes it may be necessary to give baby
antihistamine if the itch is very intense and is making the baby very
irritable.
Sometimes the eczema can become infected by bacteria and
this causes extensive redness, swelling and weeping of the affected area. In
this case it may be necessary for the doctor to prescribe an antibiotic cream
together with a steroid cream. Children with severe eczema usually also have
hay fever and asthma.
 Urticaria or hives are red or
pink raised areas on the skin that are very itchy and warm to the touch. It may
appear on any part of the body and usually last from a few hours to a few days,
but can stay for weeks or even months in some cases. Hives are usually caused
by food allergies with the most frequent culprits being eggs, shellfish,
chocolate, food additives, colouring or preservatives. It can also be due to
allergy to certain drugs or in response to contact with animals especially cats
or from insect bites.
It may come on after exposure to extreme temperature
especially heat or chemicals. Most often hives will disappear on its own after
the allergic reaction is over. If it causes itching and discomfort, the doctor
may prescribe an oral antihistamine and calamine lotion to apply on the
rashes. Avoid giving your child allergy
causing food until the hives have subsided. Later try to find the offending
culprit by reintroducing the food item one at a time and once you know the
offending food it is important to let your child's caretakers or school
teachers know so that the food is avoided. This is because very rarely, hives
can develop in the mouth and throat which can obstruct the child's airways. You
can put this information on sticker labels on your child's feeding utensils especially
in preschools when your child is too young to tell the caretakers.
Traditional Chinese therapy recommends not bathing the child
as it will cause more rashes to appear and make the rash itch more. Treatment
is to heat up some rice wine and apply it on the rashes 3 times a day. Most
often the rashes will disappear after 2 days.
 Hand foot and mouth disease
(HFMD) is a skin rash with flat
or raised red spots on the palms of the hands and soles of the feet and
sometimes on the buttocks. Often the rash will form tiny blisters which look
like the chickenpox rash but it does not itch. A day or two later the child may
develop sores or blisters on the tongue, gums and inside of the cheeks. They
begin as small red spots on the tongue, gums or mucous membranes which then
develop into blisters or sores.
It is caused by Coxsackie virus A16 which belongs to a group
of viruses called enterovirus and is normally not serious. Infection is spread by direct contact with
saliva, nose and throat discharges, fluid from the blisters or the stool of an
infected person who is most contagious during the first week of the illness. All
infected cases recover without medical treatment by 7 to 10 days. It is most
common between ages 6 months and 4 years. Very rarely, it may be caused by
another strain of Coxsackie virus EV71 whereby the child develops aseptic
meningitis or encephalitis (Inflammation of the brain). This strain may be
fatal as in the case in
Treatment is to
provide relief from fever or pain from the mouth ulcers and give plenty of
fluids. There is no immunization for HFMD.
 Thrush or candidiasis is a
fungal infection from Candida albicans. It appears as a red bumpy rash in the diaper
area and the bumps are sometimes pus-filled. It may be worse in the skin folds
and does not respond to diaper cream. Often the primary source of infection is
in the mouth which then spreads to the nappy area from the contaminated stools.
It normally starts as a couple of white patches on the sides of the mouth and
if not treated quickly can spread until the tongue is coated as well. This
makes it painful for baby to suckle. The
creamy patches look like milk curds and therefore is easily missed. Use a
cotton bud to wipe the white patches. If the patches cannot be removed it
confirms that the baby has thrush therefore should be taken to the doctor who
may prescribe Daktarin gel for the oral thrush and cream for the nappy area. If
the infection is severe it may be necessary for the doctor to prescribe Daktacort
which has a small amount of steroid in it to speed up the healing process. All
feeding equipment must be boiled thoroughly for 10 minutes to prevent
recurrence.
 Roseola infantum or false measles is a
viral illness in young children between the ages of 6 months and 2 years. The
rash is pink and may have small flat spots or raised bumps. These spots may
have a lighter "halo" around them and may turn white if you press on
them.
Roseola
usually starts out with a sudden high fever often over 103° Fahrenheit or 39.5°
Celsius. During this time, the child may appear fussy or irritable and may have
decreased appetite, mild diarrhoea and swollen lymph glands in the neck. The
fever typically lasts three to five days and end abruptly followed by the
telltale rash which is
usually seen on the trunk and neck, but it can extend to the limbs and face. The
rash may last for several hours or days.
A diagnosis of roseola cannot be made until the fever drops and the rash
appears, so the doctor may order tests to make sure that the fever is not
caused by another infection.
Roseola is contagious and spreads through tiny drops of
fluid from the nose and throat of infected people. There is no known way to
prevent the spread of roseola. Repeat cases of roseola may occur, but they are
not common.
Treatment is to keep your baby well hydrated with lots of fluids and to
control the fever to prevent a febrile seizure as about 10 to 15 percent of
children with roseola have a febrile seizure.
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