Q&A newborn
Please note that experts unfortunately cannot respond to each question personally. The answers provided on these pages should not replace the advice of your doctor.
Q My newborn is six weeks old. She had the most beautiful smooth skin, but since a week ago she developed small white pimples on her face. It’s quite bad. Are these spots painful and itchy? What can I do to help her?
A DR BERNARD LINDE ANSWERS:
We are all too aware of the classic description of a baby’s skin as the epitome of how beautiful skin should look like. They are ”new”, supposedly unblemished, and it surprises and upsets a lot of new parents when their baby who was so perfect at birth now suddenly erupts in an unsightly rash – on their face! Luckily, of the various types of rashes that newborns develop soon, or weeks, after birth, almost none are harmful, painful or uncomfortable to the baby, and very often the rashes don’t need to be a cause for concern or require any specific therapy.
Should such a rash make its untimely appearance, it may be worthwhile to discuss this with the baby’s doctor and also have it examined by the doctor to try and establish a diagnosis and to devise a plan of action, if needed. Although we very commonly forget this, the skin is actually the largest organ of the body, and a physical examination of the entire skin is always important. Babies very frequently have tiny white spots on the skin already when they are born, which is most prominent in the face, usually around the nose. These white pimples are called ”milia” or sometimes also ”milk spots”.
A milium is actually a tiny cyst containing the keratin that is the predominant protein that the skin, nails and hair is made of. Up to 50 percent of newborn infants will have milia on their skin, and even though it is usually seen on the nose, it can also occur on the rest of the face, scalp and, less commonly, on the upper trunk. It can even be found in the mouth and on the palate.
Unless some of these milia become infected when someone tries to ”pop” them, they are painless, causing no discomfort to the infant, and do not require any treatment. They disappear spontaneously within a few weeks or sometimes months.
There are some other forms of milia seen in older children and adults that might need more investigation, but those seen in newborn infants are almost never associated with other illnesses. Another very common condition that parents might describe as ”containing white spots” but is rather the presence of tiny pustules, is baby (or neonatal) acne or neonatal cephalic pustulosis, which often starts to appear around the age of three to four weeks and usually subsides by the age of three months.
The inflammation around the pustules and papules causes reddening of the skin as well. This is thought to be an inflammatory response to Malassezia yeast living on the skin. It is somewhat more common in boys but, like in the case of milia, rarely requires any treatment, does not cause obvious discomfort and does not result in any scarring. In more extensive cases, your doctor might consider using an antifungal cream such as ketoconazole to treat it. Beyond the age of three months, it is called infantile acne, which is a condition that’s a bit more complicated and is outside the scope of this short article. Lastly, especially during the warmer times of the year or in more humid climates, the sweat ducts in the face, neck and trunk may become obstructed causing a condition called miliaria, of which there are a couple of forms, one of which may give the appearance of tiny white spots. This is the one rash that might cause a bit of discomfort, hence its common name ”prickly heat”. No treatment is necessary. But avoiding overheating – and also occlusive ointments such as Vaseline. ●