Erythema of the skin of newborns: causes, consequences, treatment

Erythema of newborns is quite common, and it is not always physiological. Sometimes the manifestations of erythema can frighten parents, which in fact is not so dangerous. Therefore, it is necessary to distinguish between the symptoms of physiological and pathological conditions for the correct and timely tactics.

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Epidemiology

Statistics on the occurrence of erythema indicate that more than 15% of newborns have such erythema on the skin in the first week of life. Of this number of children, about 20% suffer from toxic erythema. Complications of erythema occur in only 1% of children, which proves the benign nature of this erythema.

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Causes neonatal erythema

Erythema is a reddening of the baby's skin that can occur for various reasons. When a child is born, he or she is exposed to environmental factors that have not affected him or her before. The baby's skin is exposed to the simultaneous action of pressure, sound, humidity, and temperature. All these irritants, acting on the skin, require its adaptation. Therefore, the first organ that is subject to adaptation after birth is the skin. Newborns have their own peculiarities in the structure of the skin and its appendages, which causes erythema in most infants. The epidermis of newborns is thin, it is loose, and the papillae and epidermal strands are not formed. Between the epidermis and the skin itself there is a membrane, which is characterized by its weak development. It allows thin vessels to shine through all layers of the epidermis. Blood vessels consist of the 1st row of endothelial cells, they are superficially located, and there is physiological dilation and a relatively large number of vessels in the skin, which causes such a "pinkish" color of the skin in the baby. This is what affects the appearance of erythema in a newborn. Therefore, the main reason for the appearance of erythema in a baby is a kind of adaptation of the skin to the external environment. Erythema occurs due to a significant expansion of the capillaries of the skin in response to new unusual irritants of the external environment. In the pathogenesis of the development of such physiological erythema, an important role is also played by the structural features of the skin and capillaries in infants.

There are other causes of erythema in newborns. These include hypersensitivity to proteins in mother's milk or other food components that can be passed on to the baby with milk. In this case, we are talking about toxic erythema.

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Risk factors

Taking into account the causes of erythema formation in children, risk factors can be identified:

1. a premature baby has a lower adaptive potential of the skin, therefore it is more prone to the development of erythema;
2. meconium content in amniotic fluid;
3. children from mothers with rhesus conflict;
4. children born in the summer;
5. children from mothers with severe atopic dermatitis or diabetes;
6. Newborns on artificial feeding.

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Pathogenesis

The pathogenesis of toxic erythema is the development of an allergic reaction, but there is no immunological stage. That is, when milk proteins enter the child's body, they act as histamine liberators. These proteins cause the release of histamine with the formation of the clinical picture of an allergic reaction, but there is no true allergy. Therefore, the cause of toxic erythema is an allergic reaction that is poorly corrected.

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Symptoms neonatal erythema

There are two main types of erythema: physiological and pathological.

The first signs of simple erythema appear on the second or third day after birth. This most often occurs after the first bath and removal of the vernix caseosa that protected the baby's skin. Then the baby's skin first comes into contact with the external environment. Capillaries dilate and this looks like a continuous reddening of the baby's skin. At the same time, the skin is not hot to the touch and does not cause any sensations in the baby. Therefore, he sleeps peacefully, eats and is no more capricious than usual. Such physiological erythema of newborns goes through successive stages of development and after one or two days its intensity decreases. At the same time, you can see that the skin becomes lighter and does not look as bright as before. Closer to the first week of life, erythema passes to the next stage and skin peeling occurs. In this case, the upper layer of the epidermis peels off in large layers. Most often, this occurs on the baby's stomach and back and is more pronounced in post-term babies. Erythema of newborns on the face often goes away on its own even without peeling of the skin. The duration of physiological or simple erythema in a newborn does not exceed one week. If we are talking about premature babies, they need more time to adapt, so they can have erythema for up to two to three weeks.

Toxic erythema in newborns begins to manifest itself clinically on the third to fifth day of life. Symptoms of toxic erythema are the appearance of red spots of varying size, location and intensity. These spots appear around the joints, on the stomach, on the arms, but they cannot be on the feet or palms, since the skin there has a slightly different structure. The spots can protrude above the skin and there may be blisters with a clear liquid on top. But this picture lasts only a few days and they also disappear without a trace. Such allergic erythema does not pose a potential danger to the baby's health, because it is not a true allergic reaction.

Complications and consequences

There are usually no consequences after erythema. It disappears without a trace, leaving no particular marks. There may be complications if the mother tried to "treat" the erythema very carefully. Then the most common complication may be infection of the baby's delicate skin with the development of pustulosis. This threatens the formation of blisters with purulent contents on the skin, which can lead to the spread of infection.

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Diagnostics neonatal erythema

Very often physiological erythema does not cause any special questions in parents and it quickly goes away on its own. But if we are talking about toxic erythema, then parents already begin to worry.

To diagnose erythema of newborns, both simple and toxic, a simple examination by a doctor is enough. Visually, erythema has a very characteristic appearance and an experienced pediatrician can immediately say what is wrong with the child. Differential diagnostics should be carried out immediately at the examination stage. It is important to differentiate toxic erythema and allergic reactions in a child. Toxic erythema never affects the feet and palms, which can be considered the main differential sign. Allergic reactions are accompanied by a rash that itches and brings a lot of unpleasant sensations to the baby. Therefore, if the child eats or sleeps poorly, or there is an increase or decrease in the child's body temperature, then physiological erythema must be excluded, since there are no general symptoms with it.

Tests and instrumental diagnostics are not performed, since erythema does not have any special changes and is a borderline condition of the newborn's body.

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Treatment neonatal erythema

Treatment of neonatal erythema is usually not required. Symptoms and manifestations disappear on their own within a week or two. However, there may be limitations when toxic erythema is expressed throughout the body. Then antihistamines can be used systemically.

Fenistil is one of the few drugs that can be used in children in the first six months of life. The active ingredient of the drug is Dimethindene. It blocks the action of histamine, which can affect the severity of the reaction in toxic erythema. The dosage of the drug is two drops three times a day, it can be used even undiluted. Side effects can manifest themselves in the form of drowsiness, dry mucous membranes, agitation, which occurs with a high dose of the drug.

If the erythema is already passing and peeling of the skin remains, then you can use the oil after bathing the baby. It softens the skin and reduces the severity of peeling, dryness and irritation.

In case of toxic erythema, you should not squeeze the papules or vesicles, as this can cause complications. It is best to consult a doctor and he will confirm that nothing needs to be done, and this condition will pass on its own.

Prevention

Prevention of complications with erythema is minimal intervention on the part of parents, which will help the skin adapt to environmental factors on its own.

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Forecast

The prognosis for erythema is always favorable.

Erythema neonatorum is the appearance of red skin or red spots on the third to fifth day of a child's life. And the main thing that parents should remember is that this is a state of skin adaptation and it will pass on its own without external intervention.

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