Skin and Scalp Concerns of Healthy Babies

Sometimes parents become concerned about the appearance of the skin or scalp in healthy young babies. The following are the common concerns which will require no treatment and will go away naturally.

Milia. These are tiny yellow or white spots which usually occur on the face. They occur in most babies, some having more than others. They are tiny cysts due to secretions of the tiny skin glands. They are normal and always go.

Hair falling out. It is normal for some hair to fall out about 2 to 3 weeks after birth. Sometimes the back of the head goes bald. Don't worry as this is only temporary and normal hair will grow back in time.

Skin peeling. Slight peeling of the skin commonly occurs in new born babies. This typically affects the hands and feet. New skin forms from underneath. It is of no concern.

Mongolian blue spot. This is an area of bluish skin which looks like a faint bruise (sometimes it is indeed confused with a bruise). It can occur in many parts of the baby`s body but is typically seen on the lower back and buttock area. It is very common in babies of Asian and African origin but less common in European babies. Its cause is unknown. It is of no concern and usually disappears in 2 to 3 years.

Scurfy scalp. Almost all babies develop some degree of scurfiness. It lasts for a few weeks and then disappears. If particularly severe, medicated shampoos can help lift the scurf. Babies are not at all bothered by it.

Naevi. To have little red marks on the skin is extremely common. These are due to collections of tiny blood vessels under the skin. Commonly they are seen on the forehead, eyelids and the back of the neck. They are so common that they are often referred to as 'stork marks' ie. where the stork put the baby in its beak before delivering him or her under the gooseberry bush! They always disappear.

Strawberry naevus. This can affect any part of the body. It is not usually seen at birth. After several days a small red patch on the skin grows and looks like the surface of a strawberry. It is due to a collection of tiny blood vessels under the skin. It can grow for up to six months, typically to the size of a small strawberry. It then gradually heals from the centre and eventually fades away altogether leaving no trace. In half of those affected there will be no trace by age five, the remaining half will be gone by age ten. It always eventually disappears leaving no mark and it is harmless. It should not be removed by an operation as this will leave a scar. Only in very rare cases where it is in a critical position (eg. next to an eye) will surgical removal be considered.

© EMIS and PIP 2004   CHIQ Accredited

Comprehensive patient resources are available at www.patient.co.uk

Scalp Ringworm

What is ringworm?

Ringworm is a fungal skin infection. (It is not due to a worm as its name implies!) There are many types of fungus germs (fungi) and some can infect the skin, nails and hair. Examples of fungal infections are: ringworm on the body (tinea corporis); scalp ringworm (tinea capitis); and athlete's foot (tinea pedis).

This leaflet deals only with scalp ringworm which mainly affects children and is rare in adults. (Other leaflets deal with fungal infections of the feet, skin and nails.)

How can you catch ringworm?

• Most cases occur for no apparent reason. Fungi are common and an infection can occur 'out of the blue'.
• From animals. Some dogs, cats and other pets have fungal infections on their skin. They can pass on the infection, especially to children. (Animals can be treated too if you suspect a pet is the cause. See your vet.) Farm animals can also be a source. Touching a farm gate where infected animals pass through may be enough to infect your skin.
• From person to person via close touching, sharing towels, etc. Sometimes an outbreak of scalp ringworm occurs in families or schools.

What does the rash look like?

Sometimes the infection just looks like severe dandruff on various places on the scalp. This may be mistaken for psoriasis. Some people develop patches of hair loss (bald patches). The 'bald patches' are usually very scaly. A more severe infection can cause a large 'boggy' swelling in a section of the scalp called a kerion. Some people develop several painful pustules (boils) on the scalp. The glands in the neck may swell if you have a severe infection.

Your doctor may send a hair sample or a 'scraping' of affected skin to the laboratory to confirm that a fungus is the cause of the problem.

What is the treatment for scalp ringworm?

Antifungal medicine
Griseofulvin, an antifungal medicine, is the usual treatment for children. It is the only antifungal medicine licensed to treat children in the UK. An 8-12 week course is usually needed. It is important to finish the course to clear the fungus completely from the scalp. Adults with scalp ringworm can also take griseofulvin. However,

• You should not take it if you are pregnant.
• Men should not father a child within 6 months of treatment.

Other antifungal medicines such as terbinafine and itraconazole are alternatives for adults. They work quicker than griseofulvin. They may become available for children in the future once they have been shown to be safe for children to take.

Antifungal creams and shampoos
Antifungal creams or shampoos do not clear the infection fully. This is because fungi get into the hair shafts where creams and shampoos cannot reach. Therefore they cannot cure the condition. However, they do clear the fungus, and the fungus spores, from the hairs and surface of the scalp. So, selenium shampoo or povidone-iodine shampoo may be advised in addition to griseofulvin medication. This is to quickly clear any surface fungi and make it much less likely for the fungus to spread to other children.

Children do not need to stay off school once treatment has started.

Preventing the spread of scalp ringworm

After a child is diagnosed as having scalp ringworm, other family members, school friends, and pets may need to be checked for fungal skin infections.

© EMIS and PIP 2004   Updated: April 2003   CHIQ Accredited   PRODIGY Validated

Comprehensive patient resources are available at www.patient.co.uk