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

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

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

Epidemiology

Statistics of the appearance of erythema suggests 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 only in 1% of children, which proves the benign nature of this erythema.

[12], [13], [14], [15], [16], [17]

Causes of the erythema of newborns

Erythema is a redness on the skin of a baby, which can occur due to various reasons. When a child is born, he encounters the influence of environmental factors, which previously did not affect him so much. The baby's skin lends itself to the simultaneous action of pressure, sound, humidity, and temperature. These all stimuli, acting on the skin, require adaptation of it, that is adaptation. Therefore, the first organ that is prone to adaptation after birth is precisely the skin. Newborn babies have their own features of the structure of the skin and its appendages, which causes the manifestation of erythema in most babies. The epidermis of the newborn is thin, it is loose, and the papillae and epidermal cords are not formed. Between the epidermis and the skin itself is a membrane, which is characterized by its poor development. It allows thin vessels to shine through all layers of the epidermis. The blood vessels consist of the first row of endothelial cells, they are superficially located, and there is a physiological dilatation and a relatively larger number of vessels in the skin, which causes such a "rosy" skin color in the baby. This is what affects the appearance of erythema in a newborn. Therefore, the main cause of the appearance of erythema in the 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 environmental stimuli. In the pathogenesis of the development of such physiological erythema, an important role is played also by the features of the structure of the skin and capillaries in infants.

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

[18], [19], [20], [21], [22]

Risk factors

Given the causes of the formation of erythema in children can identify the risk factors:

1. a premature baby has an adaptive skin potential lower, therefore more prone to developing erythema;
2. the content of meconium in the amniotic fluid;
3. children from mothers with Rh-conflict;
4. children born in summer time;
5. children from mothers with severe atopic dermatitis or diabetes mellitus;
6. newborns on artificial feeding.

[23], [24], [25], [26], [27]

Pathogenesis

The pathogenesis of the formation of toxic erythema is the development of an allergic reaction, but there is no immunological stage. That is, when milk proteins get into the child's body, they work as histamine-liberators. These proteins cause the secretion of histamine with the formation of a clinic of an allergic reaction, but there is no true allergy. Therefore, the cause of toxic erythema is an allergic reaction, which is poorly adjusted.

[28], [29], [30], [31], [32], [33]

Symptoms of the erythema of newborns

There are two main types of erythema - the physiological and pathological.

The first signs of simple erythema appear on the second or third day after birth. This occurs most often after the first bathing and removing the original lubricant, which protected the skin of the baby. Then the first contact of the child's skin with the external environment takes place. There is an expansion of the capillaries and it looks like a 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 quietly, eats and fusses no more than usual. Such physiological erythema of newborns passes through successive stages of development and after one or two days its intensity decreases. In this case, you can see that the skin becomes lighter and not so bright it looks, as before. Closer to the first week of life, erythema passes into the next stage and exfoliates the skin. In this case, the upper layer of the epidermis exfoliates in large layers. Most often it occurs on the abdomen and back of the child and is more pronounced in the portable children. Erythema of newborns on the face often passes by itself even without peeling of the skin. The duration of physiological or simple erythema in a newborn does not exceed one week. If it is a question of preterm, then they need more time to adapt, so they can have erythema up to two to three weeks.

Toxic erythema in newborns begins to clinically manifest itself on the third-fifth day of life. Symptoms of toxic erythema are the appearance of red spots of different size, localization and intensity. These spots appear around the joints, on the abdomen, on the handles, but they can not be on the feet or palms, since the skin there has a slightly different structure. Spots can protrude above the skin and there may be bubbles with a transparent liquid on top. But this picture is kept only a few days and they also disappear without a trace. Such an allergic erythema does not pose a potential danger to the health of the baby, because there is not a true allergic reaction.

[34], [35]

Complications and consequences

There are usually no effects after erythema. It disappears without leaving a trace, leaving no special traces. There can be complications if the mother very carefully tried to "treat" erythema. Then the most frequent complication can be infection of the tender baby skin with the development of pustules. This threatens the formation on the skin of the blisters with purulent contents, which can lead to the spread of infection.

[36], [37], [38], [39], [40], [41], [42]

Diagnostics of the erythema of newborns

Very often, the physiological erythema in the parents does not cause any special questions and it quickly passes by itself. But if it is a question of toxic erythema, then parents are already beginning to worry.

To diagnose the erythema of newborns, both simple and toxic, a simple examination of the doctor is sufficient. Visually, erythema has a very distinctive appearance and an experienced pediatrician can immediately say that with a child. Differential diagnosis should be carried out immediately during the inspection phase. It is important to differentiate the toxic erythema and allergic reactions in the 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 a child badly eats or sleeps, or there is an increase or decrease in the temperature of the child's body, then it is necessary to exclude physiological erythema, since with her there are no general symptoms.

Analyzes and instrumental diagnostics are not carried out, since erythema has no special changes and is a borderline condition of the newborn's body.

[43], [44], [45], [46]

Treatment of the erythema of newborns

Treatment of erythema of newborns, as a rule, is not required. Symptoms and manifestations disappear by themselves in a week or two. There may be limitations when the toxic erythema is expressed throughout the body. Then you can use antihistamines systemically.

Fenistil is one of the few drugs that can be used for children of the first six months of life. The active substance of the drug is Dimethinden. It blocks the action of histamine, which can affect the severity of the reaction with toxic erythema. Dosage of the drug - two drops three times a day, can be used even in undiluted form. Side effects can be manifested in the form of drowsiness, dryness of mucous membranes, excitation, which happens with a high dose of the drug.

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

With toxic erythema, you can not squeeze 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 state will pass by itself.

Prevention

Prevention of the occurrence of complications with erythema is a minimal intervention from the parents, which will help the skin adapt itself to environmental factors. 

[47], [48], [49], [50], [51], [52]

Forecast

The prognosis of erythema is always favorable.

Erythema of newborns is the appearance of red skin or red spots on the third or 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 itself without external interference.

[53], [54], [55], [56], [57], [58], [59], [60], [61]