Dermatitis in infants. When does it appear?

Дерматит при кърмачета

I know it's scary when a strange rash appears on a baby's delicate skin. For 5 years I have been an aunt of a young lady and my sister's first speed dial number. Dermatitis (eczema) of the skin in infants can occur at different periods of growth and can be a manifestation of various diseases. The most common in this period are atopic, seborrheic and "diaper" dermatitis. What is each of them?

Diaper dermatitis

I start with it because the probability of it happening to every baby at least once is high and can actually occur in the first days after discharge from hospital. The skin of the baby has a number of differences compared to the adult's one. One of the them is that the pH of a newborn's skin is 6.6-7.5 (in an adult it is 4.5-6). In the diaper area, the pH is even more alkaline due to compounds from urine and feces. The alkaline-acid balance leads to an imbalance in the skin microbiome, favors the proliferation of Candida albicans (fungal infection). On the other hand, ammonium compounds in the urine lead to swelling and redness, which are complemented by constant friction and a impaired skin barrier. Allergic contact dermatitis in the diaper area is not uncommon aswell. It occurs due to a hypersensitive reaction to chemicals from the production process of the material.

The best treatment is to maintain dry skin and an intact skin barrier. This is done by frequently changing the diaper and using appropriate cosmetics as a texture. I recommend oily creams which do not allow the excrements to come into contact with the skin surface. In the presence of Candida, antifungal treatment should be given. In case of allergic dermatitis, another brand of diapers should be sought.

Atopic dermatitis

Atopy is a syndrome that includes the diseases bronchial asthma, allergic rhinitis, allergic conjunctivitis and atopic dermatitis. The skin manifestation is rarely seen before the second and third month of breastfeeding age, usually starts after that. Study group describesthat a large proportion of cases are related to a family history of atopy, and about 30% of children with atopic eczema develop asthma in the future. The symptoms are most common in the cheeks with redness and roughness of the skin. On examination, mothers often describe it "as if their cheeks were sprinkled with sand or sugar." Sometimes the skin is secretory, crusts can form and the area around the mouth and nose remains unaffected and forms a "pale triangle". The limbs and abdomen are also involved in eczema and the baby is restless because the rash is accompanied by itching.

The treatment is complex and requires a special readjustment in the parents regarding the daily care of the child. In the first place, irritants from the external environment (washing powders, perfumes and scented cosmetics, flowers, patterned clothes and clothes made of artificial material, pets, etc.) should be excluded. Bathing and every washing of the baby should be with medical cosmetics for atopic skin, which contains the required type and concentration of lipids. The same applies to cosmetics after bathing, which must be applied daily. In case of exacerbation of atopic eczema, active substances from the group of low-potency corticosteroids and calcium neurin inhibitors are considered for a short time.

Seborrheic dermatitis a.k.a. cradle cap

Cradle cup in infants is a manifestation of early seborrheic dermatitis. The exact cause is not yet clear, but it is believed that maternal hormones released into the newborn before birth stimulate the production of more sebum by the sebaceous glands. Another hypothesis is associated with the fungus Malassezia. The first symptoms may begin in the first month of the baby, which differentiates it from atopic dermatitis. The forehead area is most often involved, but the entire scalp can also be affected. White-yellow scales or crusts are observed, which are difficult to remove. Similar changes can be observed in the ear canal and inguinal folds (groin). Discreet reddening of the skin may be observed, but as a rule the rash does not itch or hurt.

No medical treatment is usually required. Properly selected shampoo and lotion deal with the crusts after several applications. My advise is that the therapy should be appointed by a pediatrician or dermatologist, who will monitor the process in dynamics.

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