Caring for Your Newborn's Acne and Other Skin Problems

Parents often dream of what their new baby may look like, thinking about a pink, round, chubby-cheeked and gurgling wonder. It may be surprising for many parents to see their newborn the first time - wet and red, with a long head, and screaming - nothing at all like they had imagined.

Newborns have many variations in normal appearance - from color to the shape of the head. Some of these differences are just temporary, part of the physical adjustments a baby goes through. Others, such as birthmarks, may be permanent. Understanding the normal appearance of newborns can help you know that your baby is healthy. Some of the normal variations in newborns include the following, and are explained below:

• Color

  A baby's skin coloring can vary greatly, depending on the baby's age, race or ethnic group, temperature, and whether or not the baby is crying. Skin color in babies often changes with both the environment and health.

  When a baby is first born, the skin is a dark red to purple color. As the baby begins to breathe air, the color changes to red. This redness normally begins to fade in the first day. A baby's hands and feet may stay bluish in color for several days. This is a normal response to a baby's immature blood circulation. Blue coloring of other parts of the body, however, is not normal.

  Some newborns develop a yellow coloring called jaundice. This may be a normal response as the body rids excess red blood cells. However, it may indicate a more serious condition, especially if the yellow color appears in the first day and worsens. Jaundice can often be seen by gently pressing on the baby's forehead or chest and watching the color return. Laboratory tests may be needed to assess jaundice.

• Molding

  Cranial molding is the elongation of the shape of a baby's head. It occurs when the movable bones of the baby's head overlap to help the baby pass through the mother's birth canal. Normal shape usually returns by the end of the first week.

• Vernix

  This is a white, greasy, cheese-like substance that covers the skin of many babies at birth. It is formed by secretions from the baby's oil glands and protects the baby's skin in the amniotic fluid during pregnancy. Vernix may not be present in babies who are born postterm (after 41 weeks of pregnancy). It does not need to be removed and usually absorbs into the skin.

• Lanugo

  This is soft, downy hair on a baby's body, especially on the shoulders, back, forehead, and cheeks. It is more noticeable in premature babies, but is not usually seen in babies born very late in pregnancy.

• Milia

  Milia are tiny, white, hard spots that look like pimples on a newborn's nose. They may also appear on the chin and forehead. Milia form from oil glands and disappear on their own. When these occur in a baby's mouth and gums, they are called Epstein pearls.

• Stork bites

  These are small pink or red patches often found on a baby's eyelids, between the eyes, upper lip, and back of the neck. The name comes from the marks on the back of the neck where, as the myth goes, a stork may have picked up the baby. They are caused by a concentration of immature blood vessels and may be the most visible when the baby is crying. Most of these fade and disappear completely.

• Mongolian spots

  Mongolian spots are blue or purple-colored splotches on the baby's lower back and buttocks. Over 80 percent of African-American, Asian, and Indian babies have Mongolian spots, but they occur in dark-skinned babies of all races. The spots are caused by a concentration of pigmented cells. They usually disappear in the first four years of life.

• Erythema toxicum

  Erythema toxicum is a red rash on newborns that is often described as "flea bites." The rash is common on the chest and back, but may be found all over. About half of all babies develop this condition in the first few days of life. It is less common in premature babies. The cause is unknown but it is not dangerous. Erythema toxicum does not require any treatment and disappears by itself in a few days.

• Acne neonatorum "baby acne"

  About one-fifth of newborns develop pimples in the first month. These usually appear on the cheeks and forehead. It is thought that maternal hormones cause these, and they usually disappear within a few months. Do not try to break open or squeeze the pimples, as this can lead to infection.

• Strawberry hemangioma

  This is a bright or dark red, raised or swollen, bumpy area that looks like a strawberry. Hemangiomas are formed by a concentration of tiny, immature blood vessels. Most of these occur on the head. They may not appear at birth, but often develop in the first two months. Strawberry hemangiomas are more common in premature babies and in girls. These birthmarks often grow in size for several months, and then gradually begin to fade. Nearly all strawberry hemangiomas completely disappear by nine years of age.

• Port wine stains

  A port wine stain is a flat, pink, red, or purple colored birthmark. These are caused by a concentration of dilated tiny blood vessels called capillaries. They usually occur on the head or neck. They may be small, or they may cover large areas of the body. Port wine stains do not change color when gently pressed and do not disappear over time. They may become darker and may bleed when the child is older or as an adult. Port wine stains on the face may be associated with more serious problems. Skin-colored cosmetics may be used to cover small port wine stains. The most effective way of treating port wine stains is with a special type of laser. This is done when the baby is older by a plastic surgery specialist.

• Newborn breast swelling

  Breast enlargement may occur in newborn boys and girls around the third day of life. In the first week, a milky substance, sometimes called "witch's milk," may leak from the nipples. This is related to the mother's hormones and goes away within a few days to weeks. Do not massage or squeeze the breasts or nipples, as this may cause an infection in the breast.

• Swollen genitals/discharge

  A newborn's genitals may appear different depending on the gestational age (the number of weeks of pregnancy). Premature baby girls may have a very prominent clitoris and inner labia. A baby born closer to full-term has larger outer labia. Girls may have a small amount of whitish discharge or blood-tinged mucus from the vagina in the first few weeks. This is a normal occurrence related to the mother's hormones.

  Premature boys may have a smooth, flat scrotum with undescended testicles. Boys born later in pregnancy have ridges in the scrotum with descended testicles.