Skin flaking on the body, head, face, hands and feet in a newborn: causes, treatment

Why does a newborn's skin peel and what to do? Young parents are often concerned about this question, and they do not know whether this is normal or whether it is an allergy. It must be said that in certain cases this may be a normal phenomenon, but sometimes it is really worth thinking about a disease. Therefore, it is important to know about the symptoms that may be along with peeling skin and may indicate a pathology.

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Epidemiology

Statistics show that peeling skin occurs in more than 76% of children. Most of these cases are due to post-term pregnancy or thermal disturbances, and only about 22% are the result of allergic reactions. More than 13% of children in the first year of life have peeling skin due to atopic dermatitis.

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Causes flaky skin in a newborn

Newborn babies have some peculiarities in the structure of their skin, which can influence certain skin rashes.

The skin plays an important physiological role in the child's body. It is closely connected with the environment, it is a kind of indicator of the state and conditions of the intrauterine development of the baby, as well as pathological changes in individual organs and functional systems.

The epidermis of newborns is thin, its thickness is 0.15-0.25 mm, it is loose. They do not have papillae and epidermal strands, which can cause rapid irritation of the skin and its peeling. Morphologically more mature epidermis in the area of the legs and arms. In newborns, the development of the epidermis is uneven - it is thin on the face and in the folds, as a result of which babies have soft and velvety skin. The older the child gets, the more the epidermis is replaced by a multi-layered layer of epithelium, which is constantly subject to the process of keratinization. Its thickness varies depending on age, for example, on the shoulders and forearms 0.08 - 1 millimeters, on the palms - from 0.5 to one and a half millimeters.

The upper layer of the skin consists of several types of cells. The stratum corneum is formed by two or three rows of flat, anuclear cells. There are very weak intercellular connections here, and it also contains a lot of water, which explains easy desquamation and the formation of pathological conditions (diaper rash, maceration, peeling). This leads to the fact that such a thin layer has a low level of protective function. In older children, the epidermis consists of thin, anuclear cells filled with keratin. It contains 10% water. The stratum corneum is the thickest layer of the epidermis. It is characterized by resistance to various external irritants, and it also delays the evaporation of water. The constant process of exfoliation of the outer layer leads to peeling of the entire skin.

Between the epidermis and the skin proper there is a membrane, which is characterized by its weak development. The skin proper or dermis easily separates from the epidermis, forming blisters or erosions.

Sweat glands in the neonatal period of the baby are able to function, but their development is weak, since the exit from the ducts is closed by epithelial cells. They are fully formed and function normally only by the 3-4th months of life. This is what can affect the fact that when the child sweats, there is no such sweating, but rather it is accompanied by peeling. The full development of apocrine sweat glands ends in the 1st year of life. Insignificant functional activity of these glands due to insufficient differentiation of the brain centers regulating sweating can lead to slight overheating of the child and, as a result, peeling of the skin.

Therefore, one of the most common causes of peeling skin in a newborn is overheating. Since the baby practically does not sweat, then in this case, peeling of the skin will occur in areas where there is clothing or in areas that touch the bed.

The blood vessels consist of the 1st row of endothelial cells, they are superficially located, and there is physiological dilation and a relatively larger number of vessels in the skin, which causes such a “pinkish” color of the baby's skin.

Such features of the skin structure lead to the fact that peeling of the skin can occur under normal conditions and in the norm, for example, when the child is dressed too warmly or the air in the room is dry. Also, the cause of peeling can be synthetic clothing in the baby, which irritates the delicate and thin skin of the baby.

If a child is born from a post-term pregnancy of more than 41 weeks, then his skin after birth is "in wrinkles", and after the first bath it begins to gradually peel off. This is also considered normal and does not require any intervention.

One of the common causes of peeling skin in a newborn, as a manifestation of a pathological process, is considered to be an allergic reaction. It is very important to notice other manifestations of allergy and identify areas where peeling occurs. Sometimes after suffering allergic dermatitis, children still have peeling skin for a long time. The pathogenesis of the formation of such areas of hyperkeratosis in allergies is explained by the fact that histamine causes rejection of the upper cellular layer of the skin and leads to constant peeling.

Peeling of the skin in a newborn can occur after an infectious process. Often infectious diseases such as scarlet fever, pseudo tuberculosis can cause peeling of the skin even in large layers. But such diseases occur in older children, so this is a rare cause in newborns.

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Risk factors

Risk factors for peeling skin in newborns are limited to the following cases:

1. a baby on artificial feeding has a higher risk of developing allergies;
2. incorrect room temperature or incorrect clothing of the baby resulting in overheating;
3. post-term baby;
4. improper nutrition of the mother during breastfeeding.

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Symptoms flaky skin in a newborn

Symptoms of peeling skin in a newborn may appear on the back, legs or in the fold area. In this case, peeling is combined with maceration of the skin and is most likely caused by heat or dry air in the baby's room. If the symptom of peeling skin is observed only in small areas, for example, in the chin area or on the neck, then most likely it is caused by friction of synthetic clothing. Therefore, special attention should be paid to localization and immediately think about possible causes.

When a newborn's skin peels on the body, arms, legs, this is more often observed in post-term babies. In this case, there is no clear localization of the process, since the baby's skin has been exposed to amniotic fluid for a long time and maceration has occurred. This happened equally on all areas of the skin, so peeling will be observed on all areas.

When a newborn has dry skin and it peels on the stomach, and especially after bathing it intensifies, then this may simply be a feature of the water or the products used for bathing. Sometimes parents use potassium permanganate or some herbs that are currently not recommended for bathing newborns. In this case, they can significantly dry out the baby's delicate skin. If the problem is in the quality of the water, then you need to buy special baby water for bathing, or filter the water beforehand.

It often happens that the skin on the eyebrows, behind the ears and in the folds of a newborn peels. This indicates improper care of the baby, since the skin in these areas is especially thin and if the child is not bathed or is bathed poorly, then inflammatory areas form here. This causes discomfort to the baby, itching, and after healing, the skin dries out and peeling occurs in these areas.

When the skin of a newborn baby on the face peels, especially in the cheeks or chin area, this is considered the most reliable symptom of an allergic reaction or atopic dermatitis. Atopic dermatitis is a chronic disease that is caused by an allergic reaction to food, wool, dust, and many other things in children who are genetically prone to such manifestations.

The first signs of allergic dermatitis may appear already in the neonatal period. Symptoms may be in the form of peeling or reddened skin on the cheeks, as well as all over the body. Localization of atopic dermatitis is most often the face, scalp, elbow and knee joints, less often on the extensor surfaces of the shins, hands, feet. A very characteristic symptom is a combination of peeling and rash. Elements of the rash, as a rule, in the form of erythematous swollen lesions, subsequently microvesicles, weeping areas appear, crusts and cracks are formed. For such children, red or mixed dermographism is characteristic. Such a rash is accompanied by intense itching, can be complicated by pyogenic infection with an increase in regional lymph nodes. The child is constantly active, can be capricious, has poor sleep and appetite and tries to scratch the skin somehow, injuring it. The disease occurs in attacks, the appearance of symptoms alternates with periods of remission. But during remissions, deep cracks often remain in the area of the earlobes - with weeping, secondary impetiginization. When the elbow bends, popliteal fossa or fingers are affected (especially if the child sucks his fingers). The wounds may not heal for a long time.

This rash occurs after certain foods in the diet of a nursing mother. The severity of the rash may not be intense, but in such a case, peeling always appears on the cheeks.

When the skin of a newborn on the head in the fontanelle area peels and crusts can often form, this is a kind of manifestation of atopic dermatitis in a mild form. This is called "milk scab", which should also alert you in terms of further manifestations of an allergic reaction.

Another common problem is when the skin of a newborn is red and flaky. If there are no rash elements, and the skin is simply red and this does not affect the baby's condition, then this is not a disease or an allergy. Most newborns closer to the second week of life may have physiological erythema, in which the skin becomes red. In newborns, such physiological hyperemia of the skin is associated with many factors: a significant diameter of skin capillaries, very thin epidermis and transient erythema. And against this background, peeling may appear, which does not pose any danger, although these symptoms together seem serious. Therefore, do not worry.

Complications and consequences

The consequences of peeling skin in a newborn can be the formation of cracks in the place of dry skin, which heal poorly. This can cause discomfort and burning. Complications can arise with secondary infection of such areas, which can lead to infectious skin lesions.

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Diagnostics flaky skin in a newborn

Diagnosis of skin pathologies in a newborn child should be most thorough. The research methodology includes collecting complaints, anamnesis of the disease and life, objective examination (inspection, palpation), if necessary - additional laboratory and instrumental studies.

During an objective examination of the skin, attention is paid to changes in its color, properties of hair, nails, capillaries, sensitivity, moisture, the presence of a rash, itching. It is better to evaluate the skin when the child is completely undressed. First of all, during the examination, we evaluate the skin of the face: color, the presence of "bruises" under or around the eyes (periorbital cyanosis), the color of the triangle around the mouth (perioral triangle). Be sure to pay attention to the presence of crusts and peeling on the scalp, which may suggest an allergic form of the disease. Then, with gradual further examination, we evaluate the color of the skin of the upper limbs, trunk, legs. It may be that against the background of peeling, the skin becomes red, or after bathing, the manifestations of redness and peeling increase. Such redness must be differentiated from other conditions that may occur when exposed to heat, ultraviolet radiation, when using vasodilators, as a result of excitement, screaming, agitation. In polycythemia, due to a significant increase in the number of erythrocytes and the Hb content, the skin becomes blue-purple. With significant dehydration of the body, which is observed in hypotrophy, diabetes insipidus, and a number of intestinal infections, a decrease or loss of skin elasticity is detected.

To assess the nature of changes that may indicate atopic dermatitis in a baby, it is very important to study laboratory indicators in addition to clinical signs. The following symptoms can also be considered diagnostic criteria for atopic dermatitis:

1. xerosis (dryness) of the skin;
2. hyperlinearity of the palms and soles;
3. itching with increased sweating;
4. localization of the skin process on the hands and feet;
5. recurrent conjunctivitis;
6. cracks behind the ears.

All these symptoms are diagnostic criteria for the allergic nature of peeling skin in a newborn baby, especially if we are talking about localization on the baby’s cheeks.

Tests that can be informative in allergic dermatitis are laboratory diagnostic methods (PRIST, RAST, IFA, MAST, GAST), which allow determining the content of total Ig E and allergen-specific Ig E antibodies in the blood serum. Such extended diagnostics are rarely performed in newborns; they are more often observed and the clinical picture is assessed further with age.

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Differential diagnosis

Differential diagnostics should be carried out primarily between conditions when such pathology is a skin feature and when it is a serious disease. If the baby feels well, is not capricious, does not scream, eats and sleeps well, then this is the main criterion that indicates the normal condition of the baby.

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Treatment flaky skin in a newborn

Treatment of peeling skin in a newborn directly depends on the cause of this problem. If we are talking about simple peeling due to the peculiarities of the influence of temperature, or due to increased sweating of the baby, then the most acceptable method of treatment is proper bathing and skin care of the baby after bathing.

If the baby's skin is peeling, bathing should be done only in boiled water without adding anything. After all, daily bathing eliminates contamination of the baby's skin, so there is no need to use soap or other products that additionally dry out the baby's skin. If the baby has gneiss on the head with areas of peeling skin, then the head should be well washed and steamed during bathing. Rubbing with a washcloth or any other means is not necessary. It is enough to simply lubricate with olive oil or other baby oil after bathing and easily wipe with a towel without unnecessary effort, trying to remove these crusts.

If the baby has peeling skin in the folds or on the legs, this can quickly become complicated by the formation of cracks and diaper rash. In this case, ointments are used for treatment. Ointments for peeling skin in newborns have antiseptic properties and they soften the baby's skin, preventing infection and accelerating healing.

1. Bepanten is a product whose main active ingredient is provitamin B5. When it enters a cell, it takes part in cellular metabolic processes and ensures the regeneration of each cell. The method of application can be in the form of an ointment for very dry skin, or in the form of a cream when the wounds are already beginning to heal. You need to use a small amount of cream or ointment on areas of dry damaged skin three times a day and always after bathing. There may be side effects in the form of allergic reactions. Precautions - do not use for more than two months in a row.
2. Sudocrem is an ointment that consists of zinc oxide, due to which it has antiseptic and moisturizing properties when applied to dry skin. It quickly penetrates deep into the skin and eliminates dryness and flaking due to the activation of zinc ions in the cells. The method of using the medicine is in the form of a cream, it should be applied to damaged areas of the skin after bathing. Side effects are rare, but there may be allergic reactions. Precautions - when using the cream on the face, avoid areas around the eyes.
3. Desitin is a cream for treating dry and flaky skin that can be used in newborns to prevent complications. The active ingredient in the drug is zinc in an active form that can quickly penetrate the skin and restore the water balance in the cells. The method of application is the same - lubricate dry areas of the skin several times a day. Side effects are rare.
4. Solcoseryl is an ointment used to treat peeling skin, which is accompanied by the formation of wounds and cracks that do not heal for a long time. The active substance of this drug is a product of calf blood processing, devoid of proteins. The drug increases oxygen respiration in cells, activates proliferation and restoration of the cellular composition of the skin. How to use the drug - lubricate the affected areas twice a day. Side effects - at the site of use can cause intense itching and burning.
5. Calendula ointment is a natural antibacterial and emollient. The preparation contains calendula extract, which is a natural restorer of cell structure by normalizing metabolic processes in them. Method of application - in the form of ointment on the affected areas in a small amount. Precautions - use for newborns only after a sensitivity test. Side effects may be redness and allergic reactions on the skin.

Treatment of skin peeling caused by allergic dermatitis is a more complex task. There are several directions in the treatment of such a process:

1. elimination measures and diet therapy;
2. general (systemic) treatment;
3. external (local) treatment;
4. treatment of concomitant diseases and pathological conditions;
5. treatment of complications (eg skin infections).

The leading place in children with skin peeling of allergic genesis is occupied by the elimination diet. Specialized diets have not only diagnostic and therapeutic value, but also a preventive focus. At the beginning of the examination of a newborn child, before receiving the results of allergological tests, an empirical diet is prescribed for the mother if she is breastfeeding. Such a diet involves the exclusion from the diet of food allergens suspected according to the anamnesis. It is also recommended to exclude products with high allergenic properties (milk, eggs, fish, mushrooms, coffee, chocolate, honey, citrus fruits, carrots, nuts, pineapples, etc.). Meat broths, spicy and very salty dishes, spices, marinades, canned food are excluded from the diet. However, it is necessary to individually identify the "culprit" allergen, without getting carried away by the broad exclusion of known obligate allergens from the diet, and monitor the nutritional adequacy of the nursing mother.

Despite the fact that cow's milk is the most common allergen in children of the first year of life, dairy-free diets are used for mothers. If the child is bottle-fed, then adapted mixtures based on soy protein isolate are prescribed as a substitute for cow's milk for 4-6 months. The duration of feeding with soy formula depends on the degree of sensitization and the severity of clinical manifestations. Hypoallergenic dairy products are those created on the basis of hydrolyzed proteins of cow's milk with a high degree of hydrolyzate.

The main means for systemic treatment of allergic rash in newborns are antihistamines.

• Fenistil is an antihistamine that can be taken by newborn babies. The advantage of the drug is that it can be used locally in the form of a gel or systemically in the form of drops. The dosage of the drug for newborns is 3 drops once a day. Side effects can be drowsiness of the child, decreased appetite. Precautions - use with caution in premature babies.

Another group of drugs used to treat systemic manifestations of allergy are ketotifen, sodium cromoglycate and sodium nedocromil. These drugs do not block the action of histamine, but prevent the release of biologically active amines from basophils. In this case, the action of already activated histamine continues until it is destroyed by histamine deaminase. Therefore, such drugs are used only to prevent clinical manifestations of allergy, but not to eliminate them. For the same reason, these drugs must be taken for a long time to achieve a clinical effect. Each of these drugs has certain features of influence, which leads to their advantage in various allergic diseases.

• Thus, ketotifen (Zaditen) also has a powerful and long-lasting blocking effect (H1 receptors), although this effect only manifests itself after several days of taking the drug. Ketotifen is superior to loratadine and clemastine in its effect on clinical manifestations of allergy. Therefore, ketotifen is a priority in patients with predominantly allergic skin reactions in the form of peeling, dryness and rashes.
• Sodium cromoglycate acts not only on the allergic manifestations themselves, but also on the child’s nervous system in these diseases.
• Nedocromil sodium is more powerful than cromoglycate, prevents the formation of allergic reactions by blocking the biological effects of prostaglandins and leukotrienes. The only exception is neurogenic conditioned variants of diseases. In bronchial asthma, the drug exceeds prolonged theophylline preparations and β-blockers in prophylactic activity and is not inferior to inhaled steroids. In allergic lesions of ENT organs and conjunctiva, nedocromil exhibits a pronounced effect than cromoglycate, and has the ability to enhance the effect of antihistamines when used simultaneously

Therefore, the selection of local medications should be carried out only by an experienced specialist. Desensitizing agents are widely used: 3-7% sodium salicylate solution, 5-15 ml per day for 3 weeks, intravenous sodium thiosulfate and others. Immunity is corrected - Splenin, 1-2 ml per day intramuscularly for a course of 10-12. Various types of vaccines, in small doses, also act as desensitizing (tuberculin, staphylococcal, fungal vaccines). Enterosorbents, 25% magnesium, 15 ml 2-3 times a day are of great importance. Colibacterin, bificol, bifidumbacterin, baktisubtil, linex are used for dysbacteriosis.

Folk remedies for peeling skin

Traditional methods of treatment usually involve the use of various herbs for bathing the child and softening the skin of the affected areas.

1. Chamomile herb is widely known for its antiseptic and softening properties. To prepare the medicine, you need to make an infusion of the herb. You need to brew it in boiled hot water at the rate of two bags of the herb at 20 grams per glass of water. After five minutes of infusion, you can add this solution to the baby's bath and bathe as usual. After bathing, you need to lubricate the skin with chamomile infusion with the addition of five drops of olive oil.
2. Calendula has long been known for its beneficial effects on the skin and its appendages. It restores the water balance in the cells and normalizes metabolism. You can make a 10% solution of calendula. To do this, take 20 grams of dry calendula flowers and pour 200 milliliters of warm water over them, leave for two hours. Lubricate dry areas of the skin with a warm solution 2 times a day.
3. Sea buckthorn oil is known for its softening and antibacterial properties. You can make sea buckthorn oil at home. To do this, you need to finely grind the sea buckthorn berries several times with a blender to form a paste. Drain off excess moisture. After that, add a quarter teaspoon of wax and a teaspoon of olive oil. Heat all this in a water bath and mix until a uniform consistency is obtained. Cool the ointment. Apply a small amount to peeling areas twice a day.

Homeopathy in the treatment of flaking skin can be used as a means for local application. For this purpose, use:

1. Amberan is a complex product that includes many medicinal herbs, as well as beeswax and copper sulfate in homeopathic concentration. The method of application of the product is external - in the form of a solution on the affected areas of the skin. Precautions - do not use if you are allergic to honey. Side effects are rare - there may be allergic reactions.
2. Echinacea Madaus is a product whose active ingredient is echinacea. This plant relieves increased sensitization and peeling of the skin. It is used as an ointment externally on areas of skin with peeling and other lesions. Precautions - for newborns, use only on the recommendation of a doctor.
3. Vundehil is a product that includes herbal tinctures in different concentrations. They have a preventive antibacterial and exfoliating effect. How to use - apply a thin layer to the affected areas of the skin. Precautions - the product contains alcohol, so it can leave a feeling of dryness after use, which can be eliminated with regular olive oil.

Surgical treatment of skin peeling can be used only in very severe complicated cases, for example, in the formation of phlegmon of the newborn. In acute course of skin peeling in any other uncomplicated cases, surgical methods are not used.

Prevention

Primary prevention of any skin lesions in a baby consists of avoiding any allergic irritations in a child whose family has diseases of an allergic nature. This reduces the risk of skin manifestations, as well as manifestations from the respiratory system in the future. Prevention should begin with proper bathing of the child and proper care of his skin after bathing.

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Forecast

The prognosis and course of the disease depend on the combination with other diseases. Peeling and skin manifestations may spontaneously disappear before the end of the first month of the child's life. If we are talking about allergic dermatitis, the rash may spontaneously disappear before 1.5-2 years. If the rash does not disappear before puberty, the disease takes on a permanent character with exacerbations predetermined by various factors - social, mental, climatic.

Infectious factors are of great importance in provoking the disease - with exacerbation of focal infections (ENT organs, tracheobronchitis, urinary tract infections) the allergic process worsens. Positive psychological factors (favorable environment that eliminates psycho-emotional stress) stabilize the state of remission.

Peeling skin in a newborn is a common problem that may not be a disease at all. If the child feels well and the skin areas are only slightly involved in the process, then everything can be solved by using local emollients. When peeling is a manifestation of an allergy, then a doctor's consultation is needed.

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