Kate Puttgen, M.D., F.A.A.D.

Dr. Kate Puttgen, is an assistant professor at Johns Hopkins University in the Departments of Dermatology and Pediatrics. (Amy Davis, Baltimore Sun / August 11, 2010)

First-time parents may not always know how to care for their newborn's skin or recognize common conditions. Most problems resolve themselves, and the basic rule of thumb for washing and choosing products is to go with what's simple, says Dr. Kate B. Puttgen, assistant professor in the Johns Hopkins Medicine departments of dermatology and pediatrics and assistant director of the division of pediatric dermatology and cutaneous laser center.

What are the basics that new parents need to know about washing newborns and caring for their skin?

Newborns don't need elaborate skin care. It should be very minimalist. I tell parents to keep it simple and gentle. There is no need for daily baths at this age because they can strip the baby's skin of much-needed protective oils and moisture. Bathing a few times a week or even less is plenty. Stay away from heavily scented shampoos and lotions because they can irritate the skin. Use bland, hypo-allergenic, fragrance-free products.

What about especially sensitive preemie skin?

Preemie skin is more fragile because it is extra thin and doesn't lock in moisture well, which renders it prone to damage. The same rules as above apply but consider applying petrolatum jelly a few times a day to lock in moisture and improve the skin's barrier function.

How should newborn skin be protected from the sun? Are sunblocks OK?

The best rule of thumb is to keep baby out of the sun as much as you can. If you're out with your newborn, use physical barriers like clothes, hats, umbrellas and stroller covers. Sunscreens should be avoided in newborns. They are approved for ages 6 months and older; but if in a situation with an older infant, for example a 4- or 5-month-old, using sunscreen is preferable to a sunburn. But since these children still aren't mobile on their own, parents should be able to physically shield them from the sun's harmful rays. Again, choose a fragrance-free, hypo-allergenic product. Look for brands that list zinc oxide and/or titanium dioxide as active ingredients.

What about diapers? Are cloth better?

This is a subject that generates a lot of passion for many parents, and people often feel strongly about choosing disposable or cloth diapers. While cloth diapers are more environmentally friendly, they are not always the best choice for sensitive newborn and infant skin. Modern disposable diapers actually have a lot of technological advances that wick moisture away from sensitive skin in the diaper area extremely well, and if diaper rash is a persistent problem, switching to disposable diapers is usually an important part of curing the problem. That said, for most babies who only experience occasional and mild diaper rash, the choice is up to parents, as most children will do fine with either one.

What are the most common skin problems, and how should they be treated?

Some of the most common baby skin problems include diaper rash, cradle cap and a condition called erythema toxicum, which can sometimes look scary to new parents but is really innocent.

Diaper rash presents with red inflamed patches or bumps on baby's buttocks and genital area. Prolonged exposure to stool and urine can irritate the skin leading to diaper rash. So can fungal infections. The key is changing diapers frequently as soon as they become soiled, especially with stool, which is much more irritating than urine; use a gentle wipe and occasional petrolatum jelly or zinc oxide paste to increase barrier protection. Don't use talcum powder. Avoid heavily scented baby wipes. Don't forget to wash your hands before and after diaper changes.

Cradle cap is essentially newborn dandruff. It is very common. It occurs in areas rich in oil glands in the first three months of life. Most cases of cradle cap require nothing more than gentle cleansing and patience. Petrolatum jelly or olive oil can help relieve some of the crusting. Just be sure not to aggressively pick at the scale, which can make things worse.

Erythema toxicum develops in the first few weeks after birth and can be quite dramatic in appearance, with yellow papules ringed by red skin on the face, body, upper arms and thighs. The good news is that this is a thoroughly benign condition that goes away on its own within a few weeks.

When do you need to go to the doctor?

The above conditions are typically benign and self-limiting, and don't necessarily require a visit to the doctor, but if they become bothersome or if you are worried, go ahead and see your doctor. We can help alleviate some of the discomfort by prescribing short-term use of corticosteroid ointment or antifungal cream for the more serious cases of diaper rash and gentle antifungal shampoo for persistent cradle cap. Fever associated with any rash can signal infection, so call your pediatrician. Bottom line: Any skin affliction, no matter how benign, that gets worse or lingers for too long should be checked out. And, of course, anything new or unusual warrants a checkup.

