What Can Cause a Rash on My Baby's Face?

Though rashes that develop on the face of a newborn or baby can alarm their parent, they're not uncommon. Causes of facial rash in babies range from irritation to infection. Many common facial rashes in babies, such as cradle cap, milia, and neonatal acne, are generally harmless. However, more serious causes, like infection, may require a trip to the pediatrician's office for evaluation and treatment. This article reviews common causes of facial rash in babies and when to seek medical attention.

What Does a Baby Rash on the Face Look Like?

Rashes in babies can take on many shapes and forms depending on the underlying cause. And though a rash on your baby’s face can certainly cause some alarm, in many cases, the redness and bumps that appear are completely harmless. Healthcare providers look at several characteristics of rashes to help make a diagnosis.

• Location of the rash: The rash might be in a particular part of the face, such as near the hairline or scalp, on the cheeks, nose, forehead, or around the mouth. There may also be other body parts affected.
• Pattern: A rash may appear as a blotchy area, separate spots (like pimples), or in a lacy pattern.
• Texture: raised and bumpy or flat and smooth, flaky, peeling, or crusty.
• Color: Depending on the baby's skin tone, the rash may look red, pink, purple, or gray. There may also be other colors such as white centers or yellow crust.
• Itchiness: You may notice your child scratching at the area or notice scratch marks.

There may be other clues such as other symptoms, runny nose, fever, and other areas of the body affected by the rash (like the hands and feet or torso).

Baby Eczema

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Baby eczema, also known as atopic dermatitis, is one of the most common rashes, affecting up to 1 in 4 children. Eczema is an itchy rash that can occur on the face and other body parts. It's common to see it on the forehead, cheeks, or scalp in babies. It can come and go and may have specific triggers like dry air or irritants. The rash often appears red and bumpy, and on darker skin tones may be a purple or gray hue. Babies may be noticeably bothered by the itchy rash and scratch or rub the area against things for relief. They may also have difficulty sleeping.

Treatment

According to the American Academy of Dermatology Association, there is no cure for baby eczema, but there are treatments that can control it, including:

• Bath tips: Bathe your baby in lukewarm water, using only mild soap without fragrance in dirty areas. Limit bath time to 5 to 10 minutes and do not scrub because this can irritate the skin.
• Moisturizers: Use fragrance-free cream or ointment to moisturize your baby's skin after bath time and throughout the day as needed. These thicker agents are more effective than lotion.
• Medicated topical therapies: Your baby's pediatrician or dermatologist (skin specialist) may prescribe topical medications such as corticosteroids. These can be very effective, but it's important to follow the directions of your healthcare provider. Don't use over-the-counter medications on your baby's skin without speaking with their healthcare provider first.
• Look for and avoid triggers: You may notice that certain things worsen your child's eczema and leave their skin irritated. Try to look for these triggers and eliminate them. Things like new soap, laundry detergent, and wipes can irritate the skin. A baby's drool can also worsen eczema, particularly after eating certain types of foods (such as acidic foods) or with teething. Making sure to keep the area dry and applying ointment can help.

Your child's pediatrician or dermatologist can provide individualized advice and treatment plans so your baby can get relief from this itchy and uncomfortable rash.

Cradle Cap

Another common rash in babies, known as cradle cap, occurs on the scalp and forehead. You may be alarmed by the scaly and greasy appearing patches, but they are actually quite harmless. On dark skin tones, the rash may appear pink or purple, while on lighter skin tones, it can look red. Cradle cap usually improves by the time the baby is 6 months to 1 year old.

Treatment

The American Academy of Dermatology Association recommends the following treatment for cradle cap:

• Shampoo: Choose a fragrance-free shampoo for babies. Some shampoos are specifically formulated for cradle cap. Shampooing every other day can help, but note that shampooing this frequently may not be recommended if the baby also has eczema.
• Baby oil: Placing baby oil on the scalp before shampooing it can help loosen the scales, making them easier to remove. Avoid picking or scratching at the scales, which can break the skin and lead to infection.
• Brush or comb: Brushes and combs can help get the flakes out of the hair. You can do this while shampooing the hair with a gentle brushing motion.

See the pediatrician for stubborn cases of cradle cap or in cases in which there is loss of hair, itching, pain, or odor coming from the rash.

Newborn Acne

Newborn acne, also known as neonatal acne, is a common facial rash in young babies (as in younger than 6 weeks old). A new parent might worry when they notice red spots showing up on a newborn's face, but rest assured this is a rash that is harmless and short-lived. About one in five newborns develop newborn acne. It usually shows up at around 3 to 4 weeks of age and goes away in a few weeks or months.

Newborn acne can look similar to adult acne, which may be familiar to you. It appears as comedones (bumps) and pimples or pustules scattered across the face. In babies, acne typically affects the cheeks and nose, though it may also pop up on the chin, forehead, chest, and back.

Treatment

According to the American Academy of Dermatology Association, most cases do not require any treatment beyond gentle skin care at home. This includes using a gentle soap, taking lukewarm baths, and avoiding oily products on your baby's face. Importantly, you should never apply over-the-counter products meant to treat acne on your baby's face. Your pediatrician or dermatologist can determine if further treatment is necessary.

Infantile Acne

When acne occurs on the face of a baby older than 6 weeks old, it's known as infantile acne. This is a less common situation than neonatal acne, affecting only about 2% of infants. Your child's pediatrician or dermatologist should evaluate it to determine that it is truly acne and whether there is any underlying medical condition contributing to it. Infantile acne appears as comedones and pustules, but may also cause deeper and larger lesions known as nodules and cysts.

Treatment

Most cases of infantile acne do improve on their own. As you would for newborn acne, perform gentle skin care with lukewarm baths and avoid ointments and soaps with fragrance. However, because more severe infantile acne with deeper cysts and nodules can result in scarring, your healthcare provider may recommend further treatment. This may include topical or oral medications.

In rare cases, an underlying medical condition, such as excess hormones known as androgens, may be causing the acne. Your child's healthcare provider can examine your child and order laboratory tests to look for this if necessary.

Baby Milia

Milia are tiny white bumps that appear on the skin in newborns, though adults commonly get them too. Milia are made up of dead skin cells that get trapped under the skin's surface. In babies, they are also known as milk spots and appear on the nose and cheeks. They may also appear on the eyelids. These small bumps go away on their own within a few weeks to months and do not require any special treatment.

Slapped Cheek Syndrome

Slapped cheek syndrome is a rash caused by a viral infection known as fifth disease or erythema infectiosum, caused by parvovirus B19. As the reddish rash's colloquial name suggests, it appears on the cheeks as if the cheeks have been slapped. A few days later, a rash may develop on the chest, back, arms, and legs. Your child may also have other symptoms, such as:

• Runny nose
• Cough
• Sore throat
• Fever
• Joint pain (more common in adults)

Parvovirus B19 is rarely serious; however, pregnant individuals and those with weakened immune systems can develop complications and should discuss any exposure with their healthcare provider.

Treatment

A rash caused by parvovirus B19 requires no specific treatment other than supportive care at home. Make sure your child stays well hydrated. If the rash is itchy, anti-itch treatments may help, but discuss their use with your child's healthcare provider first.

When to Contact a Healthcare Provider

In many cases, rashes on a baby's face are not serious. Some rashes, however, can be a sign of an infection, which can be serious or cause complications. A severe rash or one accompanied by concerning symptoms should always prompt a call or visit to your child's pediatrician. Contact your child's healthcare provider to discuss rashes that come with the following:

• Broken skin that bleeds or oozes fluid
• Spreading or worsening rash
• Fever
• Pain
• Severe itching
• Foul odor

Your child's healthcare provider can help determine the cause of the rash and whether any treatment is necessary.

Summary

A rash on your baby's face can have many possible causes. Though seeing a rash on your baby can be alarming, many of its possible causes are harmless and can improve with time and gentle skin care. Cradle cap and newborn acne generally don't require additional treatment, whereas eczema may require topical therapies. Severe rashes or the presence of symptoms like fever, open skin, and leakage of pus or fluid should prompt a visit to your healthcare provider for evaluation and treatment.