Peeling skin on the body, head, face, hands and feet of the newborn: reasons, treatment
Why does the skin of the newborn flake and what should I do? Young parents are often concerned about this issue, and they do not know this is normal or are allergy manifestations. I must say that in certain cases this can be a normal phenomenon, but sometimes it really is worth thinking about the disease. Therefore, it is important to know about the symptoms that can be accompanied by skin peeling and may indicate a pathology.
Epidemiology
Statistics suggest that skin peeling occurs in more than 76% of children. Most of these cases due to a delayed pregnancy or thermal disorders, and only about 22% are the result of allergic reactions. More than 13% of children in the first year of life have skin peeling due to atopic dermatitis.
Causes of the peeling skin in a newborn
Newborn babies have some features of the structure of the skin that can affect these or other skin rashes.
The skin plays an important physiological role in the child's body. Through it there is a close direct connection with the environment, it is a kind of indicator of the condition and conditions of the intrauterine development of the baby, as well as pathological changes in individual organs and functional systems.
The epidermis of the newborn is thin, its thickness is 0.15-0.25 mm, it is loose. They have not formed papillae and epidermal cords, which can cause rapid irritation of the skin and peeling it. Morphologically more mature epidermis in the legs and arms. In newborns, the development of the epidermis is not uniform, it is thin on the face and in the folds, resulting in soft and velvety skin in infants. As a child grows older, the epidermis is replaced by a multi-layered ball 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 1.5 millimeters.
The upper layer of the skin consists of several types of cells. The stratum corneum is formed from two or three rows of flat, denuclearized cells. There are very weak intercellular connections, and also contains a lot of water, which explains the easy desquamation and the formation of pathological conditions (intertrigo, 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, denuclearized 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 stimuli, and it also prevents the evaporation of water. The constant process of exfoliation of the outer layer leads to the scaling of the entire skin.
Between the epidermis and the skin itself is a membrane, which is characterized by its poor development. It is easy to detach the actual skin or dermis from the epidermis with the formation of bubbles or erosion.
Sweat glands in the neonatal period in a baby are able to function, but their development is weak, since the exit from the duct is closed by epithelial cells. They are formed completely and normally function only to 3-4 months of life. This can affect the fact that when the child sweats, then there is no such sweating, and more it is accompanied by desquamation. The complete development of apocrine sweat glands ends in the 1st year of life. Slight functional activity of these glands due to insufficient differentiation of the brain centers that control sweating can lead to a slight overheating of the child and as a result - skin peeling.
Therefore, one of the most common causes of skin peeling in a newborn is overheating it. Since the baby practically does not sweat, then in the areas where there are clothes or on the areas that touch the bed, skin peeling will occur.
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.
Such features of the skin structure lead to the fact that peeling of the skin can be in normal conditions and is normal, for example, when the child is too warmly dressed or the dry air in the room. Also, the cause of peeling may be synthetic clothing in the baby, which causes irritation of the tender and thin skin of the baby.
If the child was born from a pregnant pregnancy for more than 41 weeks, then his skin after birth "in wrinkles", and after the first bath she begins to gradually peel off. This is also considered normal and does not require any intervention.
One of the frequent causes of skin peeling in a newborn, as a manifestation of the pathological process, is an allergic reaction. It is very important to notice other manifestations of allergies and identify the areas on which the peeling occurs. Sometimes after suffering an allergic dermatitis in children for a long time there is simply peeling of the skin. The pathogenesis of the formation of such sections of hyperkeratosis in case of allergy is explained by the fact that histamine causes rejection of the upper cellular layer of the skin and leads to permanent peeling.
Skin peeling in a newborn can be after an infectious process. Often infectious diseases such as scarlet fever, pseudotuberculosis can cause skin detachment even in large layers. But such diseases occur in older children, so this is a rare reason for newborns.
Risk factors
The risk factors for skin peeling in a newborn are limited to the following cases:
- a child on artificial feeding has a greater risk of developing allergies;
- improper room temperature or wrong baby's clothing with overheating;
- born toddler;
- malnutrition of the mother during breastfeeding.
Symptoms of the peeling skin in a newborn
Symptoms of skin peeling in a newborn can appear on the back, legs or in the area of wrinkles. In this case, the peeling is combined with maceration of the skin and most likely due to heat or dry air in the children's room. If the skin flaking symptom is observed only in small areas, for example, in the area of the chin or on the neck, it is most likely caused by the friction of the clothing of the synthetic material. Therefore, localization should pay special attention and immediately think about possible causes.
When the newborn skin is flaky on the body, on the hands, on the legs, this is more often observed in the handicapped children. In such a case, there is no clear localization of the process, since the skin of the child has long succumbed to the action of amniotic fluid and maceration has arisen. This was the same in all areas of the skin, and therefore peeling will be observed in all areas.
When a newborn has dry skin and it flakes on the stomach, and especially after bathing, this is intensified, then this may simply be a feature of water or the means that are used for bathing. Sometimes parents apply potassium permanganate or some herbs that are not currently recommended for bathing newborns. In this case, they can significantly dry the delicate skin of the baby. If the problem is in the quality of water, then you need to buy special children's water and for bathing, or filter the water before that.
It often happens that the newborn skin is scaly skin on the eyebrows, behind the ears and in the folds. This indicates the incorrect care of the baby, since in these areas the skin is especially thin and if the child does not bathe or bathe badly, then inflammatory areas are formed here. This causes the baby unpleasant sensations, itching, and after healing the skin dries up and in these areas peeling occurs.
When the skin of a newborn on the face, especially in the area of the cheeks or chin, is scaly, this is considered the most reliable symptom of an allergic reaction or disease of atopic dermatitis. Atopic dermatitis is a chronic disease that is caused by an allergic reaction to food, wool, dust, and much more in children prone to such manifestations genetically.
The first signs of allergic dermatitis can appear already in the period of newborn. Symptoms can be in the form of areas of peeling or redness of the skin on the cheeks, and also throughout the body. The localization of atopic dermatitis most often is a person, the scalp, parts of the elbow and knee joints, less often on the extensor surfaces of the shins, hands, feet. A very characteristic symptom is a combination of scaling and rash. Elements of the rash, usually in the form of erythema swollen foci, subsequently there are microvesicles, wet areas, crusts and cracks are formed. For such children, characteristic red or mixed dermographism. Such a rash is accompanied by intense itching, can be complicated by pyococcal infection with an increase in regional lymph nodes. The child is always active, can be capricious, he has a bad dream and appetite and he tries to scratch the skin somehow, traumatizing it. The disease proceeds paroxysmally, the appearance of symptoms alternates with periods of remission. But during remissions, there are often deep cracks in the area of the earlobes - with dampness, secondary impetigo. If the ulnar folds, popliteal cavities, or fingers are affected (especially if the child sucks his fingers). Wounds can not heal for a long time.
There is such a rash after certain foods in the ration of the nursing mother. The severity of the rash may be non-intensive, but always on the cheeks in this case there is peeling.
When the skin of a newborn on the head in the region of the fontanel is flaky and crusts can often form, this is a kind of manifestation of atopic dermatitis in a mild form. It has the name of "dairy scab", which should also alert in the plan of further manifestations of an allergic reaction.
Another common problem is when the skin is red and flaky in the newborn. If there are no elements of rashes, and the skin is just red and this does not affect the condition of the baby, then this is not a disease or an allergy. In most newborns, closer to the second week of life, there may be a physiological erythema, in which the skin becomes red. In newborns, such physiological skin hyperemia is associated with many factors: a significant diameter of the skin capillaries, a very thin epidermis and transient erythema. And on this background, there may be peeling, which carries no danger, although these symptoms together seem serious. So do not worry.
Complications and consequences
The consequences of skin peeling in a newborn can be in the form of cracks in the place of dry skin, which do not heal well. This can cause unpleasant sensations and burning sensation. Complications can occur with secondary infection of such areas, which can lead to infectious skin lesions.
Diagnostics of the peeling skin in a newborn
Diagnosis of skin pathologies in a newborn child should be the most thorough. The research methodology includes the collection of complaints, anamnesis of the disease and life, an objective examination (examination, palpation), if necessary - additional laboratory and instrumental studies.
At objective research of a skin pay attention to change of its coloring, properties of hair, nails, capillaries, sensitivity, humidity, presence of a rash, an itch. It is better to evaluate the skin when the baby is completely naked. First of all, when examining, we evaluate the skin of the face: color, presence of "bruises" under or around the eyes (periorbital cyanosis), coloration of the triangle around the mouth (perioral triangle). Be sure to pay attention to the presence of crusts and scaling on the scalp, which may lead to the thought of an allergic form of the disease. Further, with a gradual further examination, we assess the color of the skin of the upper limbs, trunk, legs. It can be that on the background of the peeling the skin turns red, or after the bathing the manifestations of redness and flaking intensify. Such reddening must be differentiated with other conditions that can be caused by heat, UFO, with the use of vasodilators, as a result of excitement, screaming, agitation. With polycythemia due to a significant increase in the number of erythrocytes and Hb content, the skin becomes blue-purple. With significant dehydration of the body, which is observed with hypotrophy, diabetes insipidus, a number of intestinal infections, a decrease or loss of skin elasticity is revealed.
To assess the nature of the changes that may indicate atopic dermatitis in a baby, it is very important, in addition to clinical signs, to study laboratory indicators. Diagnostic criteria for atopic dermatitis can also be considered the following symptoms:
- xerosis (dryness) of the skin;
- hyper-linearity of the palms and soles;
- itching with increased sweating;
- localization of the skin process on the hands and feet;
- relapsing conjunctivitis;
- cracks behind the ears.
All these symptoms are the criteria for diagnosing the allergic nature of skin peeling in a newborn baby, especially when it comes to localizing the baby's cheeks.
Analyzes that can be informative for allergic dermatitis are laboratory diagnostic methods (PRIST, RAST, IFA, MAST, GAST), which allow to determine the serum total Ig E and allergen specific Ig E antibodies. In newborns, such an extended diagnosis is rare, they are often observed and evaluated the clinical picture further with age.
Differential diagnosis
Differential diagnosis should be carried out primarily between conditions when such a pathology is an ossification of the skin and when it is a serious disease. If the baby feels well, does not act up, does not shout, eats and sleeps well, this is the main criterion that indicates the normal state of the baby.
Treatment of the peeling skin in a newborn
Treatment of skin peeling in a newborn directly depends on the cause of the problem. If it is a question of simple peeling due to the effects of temperature, or due to excessive sweating of the baby, the most acceptable method of treatment is the proper bathing and skin care for the baby after bathing.
When peeling skin from a baby, bathing should be done only in boiled water without adding anything. After all, daily bathing excludes the contamination of the skin of the child, so there is no need to use soap or other means that additionally overdress the baby's skin. If the child has a gneiss on the head with the areas of skin peeling, then the head during bathing should be well washed and steamed. Do not rub with a washcloth or any other means. It's enough to simply oil it with olive oil or other baby oil after bathing and without effort it is easy to wipe it with a towel, trying to remove these crusts.
If the baby has skin peeling in the area of wrinkles or on the legs, then this can be quickly complicated by the formation of cracks and diaper rash. In this case, use to treat the ointment. Ointments from skin peeling in a newborn have the properties of an antiseptic and they soften the baby's skin, preventing infection and speeding up healing.
- Bepanten is a remedy whose main active ingredient is provitamin B5. He, when ingested, 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 with very dry skin, or in the form of a cream, when the wounds are already beginning to heal. Use a small amount of cream or ointment on the areas of dry damaged skin three times a day and always after bathing. There may be side effects in the form of allergy manifestations. Precautions - do not use more than two months in a row.
- Sudokrem is an ointment that consists of zinc oxide, due to which it has antiseptic and moisturizing properties when exposed to dry skin. It quickly penetrates deep into the skin and eliminates dryness and peeling due to the activation of zinc ions in the cells. The way of using the medicine - in the form of a cream, it is necessary to apply to the damaged skin after bathing. Side effects are infrequent, but there may be allergic manifestations. Precautions - When using face cream, avoid areas around the eyes.
- Desitin is a cream for the treatment of dryness and peeling of the skin, which can be used in newborns to prevent the occurrence of complications. The active substance of the drug is zinc in an active form, which 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.
- Solcoseryl is an ointment that is used to treat skin peeling, 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 processing of blood of calves, it is deprived of fibers. The drug increases oxygen breathing in cells, activates the proliferation and recovery of the cellular composition of the skin. The method of application of the drug is to lubricate the affected areas twice a day. Side effects - at the place of use can cause intense itching and burning.
- Calendula ointment is a natural antibacterial and emollient. The composition of the drug includes extract from calendula, which is a natural reductant of the structure of cells due to the normalization of metabolic processes in them. The way of application - a kind of ointment on the affected areas in a small amount. Precautions - newborns should be used only after carrying out a sensitivity test. Side effects can be in the form of redness and allergic reactions on the skin.
Treatment of skin peeling, which is caused by allergic dermatitis, is a more difficult task. There are several directions in the treatment of this process:
- elimination activities and diet therapy;
- general (systemic) treatment;
- external (local) treatment;
- treatment of concomitant diseases and pathological conditions;
- treatment of complications (eg, with skin infection).
The leading place in children with peeling of the skin of allergic genesis is the elimination diet. Specialized diets in this case have not only diagnostic and therapeutic value, but also a preventive focus. At the beginning of the examination of the newborn child, before receiving the results of allergological tests, an empirical diet for the mother is appointed if she feeds the baby with the breast. Such a diet provides for the exclusion of food allergens from the diet, suspected of anamnesis data. It is also recommended to exclude products that have high allergenic properties (milk, eggs, fish, mushrooms, coffee, chocolate, honey, citrus fruits, carrots, nuts, pineapples, etc.). Meat broths, sharp and very salty dishes, spices, marinades, canned food are excluded from the diet. However, it is necessary to individually detect the "guilty" allergen without getting carried away by the wide elimination of the known obligate allergens from the diet, and to monitor the full nutrition of the nursing mother.
Despite the fact that most often the allergen in children of the first year of life is cow's milk, dairy-free diets for the mother are used. If the child is on artificial feeding, the adapted mixtures based on the soy protein isolate are appointed as a substitute for cow milk for 4-6 months. The duration of feeding with a soy mixture depends on the degree of sensitization and severity of clinical manifestations. Hypoallergenic are dairy products, created on the basis of hydrolyzed proteins of cow 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 to newborn babies. The advantage of the drug is that the method of its application can be local in the form of a gel or systemic in the form of drops. Dosage of the drug for newborns - 3 drops once a day. Side effects can be in the form of drowsiness of the child, a decrease in appetite. Precautions - use in preterm babies with caution.
Another group of drugs that are used to treat systemic manifestations of allergy are ketotifen, sodium cromoglycate and nedocromil sodium. These drugs do not block the action of histamine, but prevent the release of biologically active amines from basophils. In this case, the effect of the activated histamine is continued until it is destroyed by histamine deaminase. Therefore, such drugs are used only to prevent clinical manifestations of allergies, but not to eliminate them. For the same reason, these funds must be taken for a long time to achieve a clinical effect. Each of these drugs has certain characteristics of influence, which leads to their advantage in various allergic diseases.
- Thus, ketotifen (Zaditen) is also characterized by a powerful and prolonged blocking effect (H1 receptors), although this effect is manifested only after several days of taking the drug. Ketotifen is influenced by the clinical manifestations of allergies is dominated by loratadine and clemastine. Therefore, the place of ketotifen in patients with predominantly allergic skin reaction in the form of peeling, dryness and rash is a priority.
- Cromoglycate sodium acts not only on the actual allergic manifestations, but also on the nervous system of the child in these diseases.
- Nedocromil sodium is more potent than cromoglicate, prevents the formation of allergic reactions due to blocking the biological effects of prostaglandins and leukotrienes. An exception is only neurogenic caused by the variants of the diseases. In bronchial asthma, the drug exceeds the prophylactic activity of prolonged theophylline preparations and β-blockers and is not inferior to inhaled steroids. In allergic lesions of ENT organs and conjunctiva, nedocromil shows a pronounced effect than cromoglycate, and has the ability to enhance the effect of antihistamines while simultaneously applying
Therefore, the selection of medicines of a local nature should be carried out only by an experienced specialist. Widely used desensitizing agents: 3-7% sodium salicylate solution for 5-15 ml per day for 3 weeks, in / in sodium thiosulfate and others. Correction of immunity - Splenin 1-2 ml per day IM per course 10-12. All kinds of vaccines, in small doses, act as desensitizing (tuberculin, staphylococcal, fungal vaccines). Of great importance are enterosorbents, magnesia 25% 15 ml 2-3 r-day. With dysbacteriosis use colibacterin, bifikol, bifidumbacterin, baktisubtil, linex.
Alternative skin peeling treatment
Alternative methods of treatment usually involve the use of different herbs for bathing the baby and softening the skin of the affected areas.
- The grass of the chamomile is widely known for its antiseptic properties and softening. To prepare the medicine you need to make an infusion of grass. Brew should be in boiled hot water at the rate of two bags of grass for 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.
- Calendula has long been known for its beneficial effects on the skin and its appendages. It restores the balance of water in the cells and normalizes metabolism. You can make a 10% solution of calendula. To do this, take 20 grams of dried calendula flowers and pour warm water in a volume of 200 milliliters, insist for two hours. Lubricate dry areas of the skin 2 times a day with a warm solution.
- Sea buckthorn oil is known for its emollient properties and antibacterial. You can make sea buckthorn oil at home. To do this, you need to grind finely the fruit of the sea-buckthorn blender several times to form a gruel. Excess moisture must be drained. After this, add a quarter teaspoon of wax and a teaspoon of olive oil. All this must be heated in a water bath and mixed until a uniform consistency is obtained. Ointment needs to be cooled. Apply in small amounts to the areas of peeling two times a day.
Homeopathy in the treatment of skin peeling can be used as a topical agent. To this end, use:
- Amberan is a complex remedy, which includes many medicinal herbs, as well as beeswax and copper sulfate in homeopathic concentration. Method of application of the drug external - in the form of a solution on the affected skin. Precautions - do not use for allergies to honey. Side effects are infrequent - there may be allergic events.
- Echinacea Madaus is a remedy whose active ingredient is Echinacea. This plant removes the increased sensitization and peeling of the skin. Used in the form of ointment externally on the skin with peeling and other lesions. Precautions - for newborns to use only on the advice of a doctor.
- Vundehil is a remedy that includes herbal tinctures in different concentrations. They have a preventive antibacterial and exfoliating effect. Method of application - externally a thin layer should be applied to the affected areas of the skin. Precautions - the preparation contains alcohol, so it can leave a feeling of dryness after use, which can be eliminated with the usual 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 skin flaking in any other uncomplicated cases, operational methods are not used.
Prevention
Primary prevention of any skin lesions of a baby is to avoid any allergic irritations in a child whose family has diseases of an allergic nature. This reduces the risk of manifestations on the skin, as well as manifestations of the respiratory system in the future. Prevention should begin with the proper bathing of the child and proper care for his skin after bathing.
Forecast
The prognosis and course of the disease depends on the combination with other diseases. Peeling and skin manifestations can spontaneously disappear before the end of the first month of life. If it comes to allergic dermatitis, the rashes can spontaneously disappear to 1.5-2 years. If the rash has not disappeared before puberty, the disease takes on a permanent character with exacerbations predetermined by various factors - social, mental, climatic.
Great importance in the provocation of the disease have infectious factors - with exacerbation of focal infections (ENT organs, tracheobronchitis, urinary tract infection), the allergic process deteriorates. Positive psychological factors (a favorable environment that excludes psychoemotional stress) stabilize the state of remission.
Skin peeling in a newborn is a common problem, which may not be a disease at all. If the child is well and skin areas are involved in a small amount of the process, then everything can be solved by using local emollients. When peeling is a manifestation of an allergy, then the doctor's consultation is already needed.
Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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