Common Skin Conditions in Infants Aged 3-6 Months
The most common skin conditions in infants aged 3-6 months include atopic dermatitis (eczema), seborrheic dermatitis (cradle cap), diaper dermatitis, neonatal acne, milia, miliaria, and cutaneous mastocytosis.
Atopic Dermatitis (Eczema)
Atopic dermatitis is one of the most prevalent skin conditions in infants, typically beginning in the first year of life.
Presentation:
- In infants: Symmetrical distribution with lesions commonly starting on the cheeks and extending to neck, trunk, and extensor surfaces of extremities 1
- Notable sparing of the diaper area 1
- Acute lesions: erythema, exudation, papules, and vesiculopapules
- Chronic lesions: lichenification, prurigo, scales, and crusts 1
Management:
- Moisturizers are the first-line therapy regardless of disease severity 1
- Apply fragrance-free emollients immediately after a 10-15 minute lukewarm bath 1
- For mild eruptions: Mild topical corticosteroids
- For severe eruptions: Higher potency topical corticosteroids for short periods
- Avoid triggers: irritants, allergens, excessive sweating, and stress 1
Seborrheic Dermatitis (Cradle Cap)
Characterized by greasy, yellowish scales primarily on the scalp.
Presentation:
- Yellow, greasy scales on the scalp that may extend to eyebrows, behind ears, and neck folds 2, 3
- Usually non-pruritic
- Can last from weeks to months 3
Management:
- Shampooing and removing scales with a soft brush after applying mineral oil or petrolatum 2
- For severe cases: tar or ketoconazole shampoo 2
- Most cases resolve spontaneously 3
Diaper Dermatitis
One of the most common skin conditions in infants in the first months post-birth 4.
Presentation:
- Erythematous rash in the diaper area
- May involve skin folds (suggests Candida infection)
- Can be irritant contact dermatitis or fungal infection
Management:
- Keep diaper area clean and dry 2
- Frequent diaper changes and open air exposure 2
- Barrier emollients to protect skin 4
- For Candida-associated dermatitis: topical antifungals 2
Neonatal Acne
Common facial eruption in young infants.
Presentation:
- Comedones or erythematous papules on face, scalp, chest, and back 2
- Usually appears within first month of life
Management:
- Typically self-limiting and resolves spontaneously 2
- If severe or persistent beyond 1 year, evaluation for androgen excess is warranted 2
Milia
Tiny white papules caused by retention of keratin.
Presentation:
- Small (1-2mm) white or yellow papules on face, particularly nose and cheeks 2
- Not inflammatory or pruritic
Management:
- No treatment necessary; resolves spontaneously 2
Miliaria (Heat Rash)
Caused by sweat retention due to blocked sweat ducts.
Presentation:
- Tiny vesicles or papules, often in skin folds or areas covered by clothing 2
- More common in hot, humid environments
Management:
- Keep skin cool and dry
- Lightweight, breathable clothing
- Resolves spontaneously with proper care 2
Cutaneous Mastocytosis
Less common but important to recognize.
Presentation:
- Urticaria pigmentosa (most common form, 70-90% of cases): red to brown macules, plaques, or nodules 1
- Mastocytomas: larger nodular lesions that may vesiculate 1
- Positive Darier's sign (wheal and flare after stroking lesions) 1
- 60-80% of patients develop lesions during the first year of life 1
Management:
- Often requires specialist consultation
- Avoidance of triggers that cause mast cell degranulation
- Most cases of childhood-onset mastocytosis resolve by puberty 1
Erythema Toxicum Neonatorum
Benign, self-limiting rash common in newborns.
Presentation:
- Erythematous macules, papules, and pustules on face, trunk, and extremities 2
- Typically appears within first week of life
Management:
- No treatment necessary
- Resolves spontaneously within 1 week 2
Important Considerations
- Skin conditions in infants can cause significant parental anxiety 5
- Education and support for parents are essential components of management
- Most infant skin conditions are benign and self-limiting
- Severe, persistent, or unusual rashes warrant specialist referral
- Avoid fragrances, harsh soaps, and potential irritants in infant skincare products
For all infant skin conditions, maintaining skin barrier function through appropriate bathing practices and regular moisturization is fundamental to management and prevention of flares.