Management of Red Raised Bumps on an 8-Month-Old Girl's Face
For an 8-month-old girl with red raised bumps on the face, the most appropriate initial treatment is a low-potency (Class 6-7) topical corticosteroid such as hydrocortisone 1%, applied sparingly to affected areas no more than 3-4 times daily, along with gentle skin care and moisturization.
Differential Diagnosis
When evaluating red raised bumps on an infant's face, consider these common conditions:
- Infantile eczema/atopic dermatitis - Most likely diagnosis; presents as red, dry, itchy patches
- Infantile seborrheic dermatitis - Greasy, scaly patches, often on scalp and face
- Contact dermatitis - Reaction to irritants or allergens
- Viral exanthem - May present with fever and systemic symptoms
- Impetigo - Honey-colored crusting suggests bacterial infection
Treatment Algorithm
Step 1: Gentle Skin Care
- Use lukewarm water for bathing (2-3 times weekly)
- Apply non-soap, fragrance-free cleansers
- Pat dry gently, avoid rubbing 1
Step 2: Topical Treatment
- Apply hydrocortisone 1% cream to affected areas up to 3-4 times daily 2
- Do not use higher potency steroids on the face of infants due to risk of skin atrophy 3
- Duration: Use for 7-10 days, then reassess
Step 3: Moisturization
- Apply fragrance-free emollients at least twice daily, especially after bathing
- Consider emollients with 5-10% urea for better hydration 3
Step 4: Trigger Avoidance
- Avoid harsh soaps, detergents, and irritating fabrics
- Maintain comfortable temperature to prevent overheating
- Change clothes when damp from sweat 3
Special Considerations
When to Consider Alternative Diagnoses
- If lesions are vesicular with fever - consider eczema herpeticum 4
- If lesions are flesh-colored with central umbilication - consider molluscum contagiosum 5
- If there are multiple café-au-lait spots - consider neurofibromatosis type 1 6
When to Refer to a Dermatologist
- No improvement after 2-3 weeks of appropriate therapy
- Widespread or rapidly progressing lesions
- Uncertainty in diagnosis 3
Monitoring and Follow-up
- Reassess after 2 weeks of treatment
- Watch for signs of:
- Secondary bacterial infection (increased redness, crusting, oozing)
- Skin atrophy from steroid use
- Treatment failure 3
Cautions
- Avoid high-potency topical corticosteroids in infants, especially on the face
- Limit application duration to prevent side effects
- Do not use topical calcineurin inhibitors (tacrolimus, pimecrolimus) in children under 2 years without specialist guidance
- Monitor for signs of infection requiring antibiotic treatment 1
Parent Education
- Explain the chronic, relapsing nature of many skin conditions
- Emphasize the importance of consistent skin care and moisturization
- Reassure that most infantile facial rashes respond well to appropriate treatment
- Demonstrate proper application technique for medications
By following this structured approach with appropriate low-potency topical corticosteroid use and gentle skin care, most cases of facial rash in infants will improve significantly while minimizing potential side effects.