Author: Gauri Kshirsagar

The skin of a baby differs from that of an adult in structure, function, and composition.The skin is the first barrier of the newborns to counter various noxious factors/ agents of the environment once the baby is born.  The skin barrier is more or less competent at birth in healthy, full-term neonates. Since, the chances of a preterm delivery is higher in case of twins, the skin of the newborn may be less developed compared to that of a full term baby. Skin problems pertaining to dryness are also common in babies due to under developed skin. Maintaining a healthy skin and preventing exposure to toxic substances in childhood assures healthy skin for several years ahead.

Difference between the skin of an adult and a baby and its implications:

1. The most important anatomical differences is: a higher skin surface area (skin surface area of infant is 700 cm2/kg as compared to adult skin which is 250 cm2/kg) to weight ratio.Hence this fact of having greater body surface area to weight ratio than adults facilitates easy absorption and toxicity of topically applied substances.
2. The permeability of the Epidermis is higher (i.e absorption of substances is higher) & epidermal barrier (i.e stuctures in the epidermis which form a barrier to keep out harmful substances) is not well developed; Hence it is more susceptible to antimicrobial attack, more apt to react to irritants and more prone to maceration due to moisture retention (e.g diaper rash)
3. Skin problems pertaining to dryness are common in babies due to inadequacies in the epidermal barrier.
4. The connection between the epidermis (top thin layer of skin) and dermis (thicker lower layer of skin) is less strong;  Blisters can be formed easily during inflammatory processes due to loose adherence of epidermis to dermis
5. The skin is thinner and less elastic in babies
6. Melanin (pigment which gives color to the skin) production is decreased. Hence newborn skin is more susceptible to ultraviolet (UV) light induced damage because of less melanin content of epidermis.
7. The sebaceous glands, although large in number at birth, have no function until puberty and similarly there are dense but less active sweat glands.

The skin of a healthy newborn at birth has:

• Deep red or purple skin and bluish hands and feet. The skin darkens before the infant takes his or her first breath (when they make that first vigorous cry).
• A thick, waxy substance called vernix covering the skin. This substance protects the fetus’s skin from the amniotic fluid in the womb. Vernix should wash off during the baby’s first bath.
• Fine, soft hair (lanugo) that may cover the scalp, forehead, cheeks, shoulders, and back. This is more common when an infant is born before the due date. The hair should disappear within the first few weeks of the baby’s life.

Newborn skin will vary, depending on the length of the pregnancy. Premature infants have thin, transparent skin. The skin of a full-term infant is thicker.

By the baby’s 2nd or 3rd day, the skin lightens somewhat and may become dry and flaky. The skin still often turns red when the infant cries.

Other changes may include:

• Milia, (tiny, pearly-white, firm raised bumps on the face) which disappear on their own.
• Mild acne (Pimples) that most often clears in a few weeks. This is caused by some of the mother’s hormones that stay in the baby’s blood.
• Erythema toxicum This is a common, harmless rash that looks like little pus filled lesions on a red base. It tends to appear on the face, trunk, legs, and arms about 1 to 3 days after delivery. It disappears by 1 week.

Birth Marks in Babies

Colored birthmarks or skin markings may include:

• Congenital Nevi are moles (darkly pigmented skin markings) that may be present at birth. They range in size from as small as a pea to large enough to cover an entire arm or leg, or a large portion of the back or trunk.
• Mongolian spots are blue-gray or brown spots. They can emerge on the skin of the buttocks or back, mainly in dark-skinned babies. They should fade within a year.
•  Café au lait are light tan, the color of coffee with milk. They often appear at birth, or may develop within the first few years.

Red birthmarks may include:

• Port-wine stains are growths that contain blood vessels (vascular growths). They are red to purplish in color. They are frequently seen on the face, but may occur on any area of the body.
• Hemangiomas are a collection of capillaries (small blood vessels) that may appear at birth or a few months later.
• Stork Bite are small red patches on the baby’s forehead, eyelids, back of the neck, or upper lip. They are caused by stretching of the blood vessels. They usually go away within 18 months.

Keep in mind the 4 points to a good and healthy skin

1. Gentle cleansing
2. Adequate hydration and moisturization of the skin,
3. Preventing friction and maceration in body-folds
4. Protection from irritants and bright sunlight.

*For more Information on Skin care routine, bathing and diaper rash management…. Check out my other posts

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