Is your precious newborn’s skin dry and peeling?
Dry skin and peeling skin are two common side effects of residing in fluid for nine months.
Remember the saying “soft as a baby’s bottom?” The truth is, infant skin is sensitive to the harsh outside environment and needs time to adapt. Fortunately, there are ways we can help it along.
In this article, we’ll discuss how to identify dry skin in babies and newborns and the best ways to treat it.
- Dry, peeling skin in newborns is common due to exposure to amniotic fluid and shedding of the vernix caseosa, which protected their skin in the womb.
- Infant eczema and ichthyosis vulgaris are other possible causes of dry skin in babies, often triggered by irritants, allergens, or gene mutations.
- To treat newborn skin peeling, minimize bath time, apply a hypoallergenic moisturizer, protect from cold air, and use gentle, unscented products.
- Consult a pediatrician if you notice sudden redness, cracked skin, itchiness, swelling, fever, or persistent dry patches on your baby’s skin.
Causes of Dry Skin in Babies
The main culprit for dry, peeling skin is exposure to amniotic fluid. Your newborn spent months surrounded by this liquid. Typically, this affects overdue babies to a greater extent. However, it isn’t until the outer skin develops that the fluid poses a threat.
Newborns that I have seen between the gestational ages of 40 to 42 weeks tend to have an excessive amount of skin peeling. By two weeks old, this peeling layer of skin sloughs off, resulting in smooth skin. Many parents ask me about using moisturizers to reduce peeling. I reassure them that moisturizers are unnecessary, and peeling skin is a normal process.
Editor's Note:Dr. Leah Alexander, MD, FAAP
Up until about 17 weeks of gestation, your baby’s skin was transparent, covered by tiny hairs, and adapted to the moist environment. But as the “normal” skin develops, a barrier called vernix caseosa forms to protect it from the various liquids.
What is Vernix Caseosa?
Around the 17th to 20th week of pregnancy, a white substance called vernix caseosa — or vernix — settles on top of the skin. This is a creamy, white matter (think cottage cheese consistency) made from water, proteins, and lipids (1).
The high water content and lipids (fats) of the vernix create two-way protection. The water prevents skin dryness, and the lipids block the surrounding fluids from direct contact with the skin.
In utero, the vernix also prevents the skin from shedding or peeling. This means there’s a buildup of old tissue ready to peel once the vernix is gone.
During the last weeks of gestation, the vernix begins to dissolve. This is why most overdue babies usually have little, while preterm babies likely have a lot on their skin after birth.
Postpartum vernix is a good thing as the vernix also acts as a natural moisturizer. My little one looked like she was covered in frosting!
Generally, the vernix disappears after five days or when your baby has their first bath. This can trigger an avalanche of skin shedding.
The most shedding typically occurs within the first two to three weeks. This is when your baby’s skin adjusts to the dry air after being submerged for so long. The new outer layer of skin will be tougher, more resilient, and ready to take on the world.
Other Possible Causes of Newborn Dry Skin
Eczema, or atopic dermatitis, is a skin condition primarily affecting children. Most will outgrow it before their teens, and only a few will still have it through adulthood.
Even though this condition mainly affects children, it is not so common in newborns. However, it does occur from time to time, and when it does, doctors refer to it as “infant eczema.” In clinical practice, the earliest signs of eczema are at 3 or 4 months old.
It is not unusual to confuse eczema with other common skin conditions, such as cradle cap. However, take a closer look, and you’ll notice the difference.
Eczema makes the skin appear thickened, dry, and scaly. Affected areas feel irritated, and tiny red bumps can develop. These can itch, blister, and ooze if scratched, increasing the possibility of infection. On the contrary, cradle cap tends to start on the scalp, then spread down the body in more severe cases. The rash is usually oily and looks like dandruff. It occasionally has fine pimples (2).
Although eczema can affect any part of the skin, it generally begins around the baby’s chest, upper arms, lower legs, or cheeks (3). Infant eczema often self-resolves by the age of 2 unless there is a family history of it. In toddlers and older children, skinfold areas such as the middle of the arms and behind the knees are affected.
If your baby has eczema, trim their nails and smooth the edges with a nail file. Many parents also use baby mittens or gloves. While your newborn can’t scratch an itch yet, long nails and waving arms can potentially break the skin.
The symptoms may disappear and reappear. These are some possible triggers for flare-ups:
- Dry skin.
- Irritants: Scratchy clothing, perfumes, and laundry soaps.
- Heat and sweat.
- Stress: This leads to flushing, which can cause irritation.
- Allergens: Dairy, soy, wheat, etc.
I have seen a few infants with mild eczema that worsened when oat cereal was introduced as one of the first foods. When I asked the parent which skin products they were using, it happened to be a colloidal-oat-based moisturizer. Once the parents discontinued both the oat cereal and that particular moisturizer, the eczema resolved.
Editor's Note:Dr. Leah Alexander, MD, FAAP
Why Does My Newborn Have Eczema?
Eczema often runs in the family. If you or your partner had this condition, other allergies, or asthma growing up, the likelihood of your baby having the same issues increases.
Other times, it could be a barrier problem in the skin, which allows moisture to escape while letting germs in.
Our body produces fat cells called ceramides. These are waxy or oily molecules that help our skin retain moisture. The skin becomes dry when the body fails to generate enough of these fatty cells.
Fortunately, eczema generally runs its course within a couple of years. And unless the symptoms are severe or seem to get worse, there’s no need to contact your doctor. They may prescribe a medical lotion or eczema cream to relieve the symptoms.
The Mayo Clinic has some helpful advice on how to manage infant eczema.
2. Ichthyosis Vulgaris
Ichthyosis vulgaris is a condition that causes dry, peeling skin that appears thick and scaly.
This skin disorder is a type of ichthyosis — a group of 20 conditions interfering with the skin’s ability to shed dead cells. Ichthyosis vulgaris is the most common type, affecting 1 in every 250 people. If you have it, there is a 50% chance your baby will inherit it (4).
Doctors often refer to this condition as “fish scale disease” since the affected areas resemble fish scales.
Ichthyosis can be tricky to diagnose in newborns. Most symptoms don’t develop until around two months. Still, it does leave clues for doctors early on.
At birth, your doctor may look for dryness around your baby’s mouth. It might appear cracked or peeling. The skin on your baby’s chest or torso will likely seem taut, as if it’s being stretched.
If your baby has hair at birth, it might look like stubble, as opposed to the usual smooth strands. Their eyebrows and eyelashes may also be missing.
Sometimes, babies with ichthyosis will also have eczema. This typically leads to worse flare-ups and may continue into adulthood.
These are some possible triggers of ichthyosis:
- Cold or dry air.
- Scented soaps and perfumes.
- Prolonged or frequent baths.
Treatment usually involves regular use of moisturizing lotions and exfoliating baths.
Why Does My Baby Have Ichthyosis Vulgaris?
Ichthyosis Vulgaris generally occurs due to a mutation in a specific gene (5). This gene’s job is to encode filaggrin, a protein that connects keratin fibers to epithelial cells.
Filaggrin creates a natural barrier for the skin to maintain healthy moisture levels and pH. Without this barrier, the skin fights to retain moisture.
As the dehydrated cells age, they begin to harden and thicken. Eventually, they move to the skin’s surface, appearing as fixed scales.
You can learn more about this condition here.
How to Treat Newborn Skin Peeling
It’s perfectly normal for newborns to experience dry and peeling skin. Before rushing to the pediatrician, there are a few remedies you can try. The AAP recommends the following (6):
1. Cut Down Bath Time
For newborns, you don’t need to use soap on areas other than hands, feet, and genitals. Their stomach, back, and other locations only need a rinse-off with water (unless there has been a poo explosion).
2. Apply a Moisturizer
To combat dry baby skin, apply a hypoallergenic moisturizer twice a day.
After baths, also use a cream, oil, or lotion. I would give my little one a massage with baby oil or coconut oil. It was a bonding time for us, and we both loved it.
Apply the moisturizer while your baby is still wet, then gently pat dry with a towel. This way, you’re sealing the moisture into the skin.
3. Minimize Exposure to Cold Air
Cold wind can be harsh on the skin, so cover your baby’s hands and feet when you go outside. You can place a loose cover over your car seat or baby carrier to protect your baby’s face. Just ensure there are no choking hazards and use a breathable fabric.
4. Cut Out Unnecessary Chemicals
Many chemicals in skin care and cleaning products are harmful to the skin, so it’s best to avoid them as much as possible.
Perfumes and scented products can especially irritate your baby’s skin and trigger a flare-up. Try using soaps or laundry detergents that are mild for your baby’s skin.
If your baby has sensitive skin but soap is really necessary, try Dr. Bronner’s Pure-Castile Liquid Soap. As it isn’t tear-free, I suggest keeping it away from your baby’s eyes, but it will soften and moisturize the skin without harsh perfumes.
You could also try washing your clothes with Puracy liquid detergent, which is plant-derived and contains no harsh chemicals. If you prefer unscented products, try Molly’s Suds, a natural powder detergent, as it’s gentle on clothes and diapers and designed for sensitive skin.
5. Stay Hydrated
Ensure your baby stays hydrated. Breast milk or formula is enough for your baby’s first 6 months. After they are 6 months old, you can offer some water. Prior to 6 months old, it is not necessary to give your baby water, and it can even be harmful.
6. Use a Humidifier
Less humidity means a higher chance of dry skin. Try using a humidifier to moisten the indoor air. This may help to prevent irritation and itchiness.
7. Soothing Oatmeal Bath
Oatmeal is excellent for many things, especially if your little one has eczema or extremely dry skin.
Colloidal oatmeal is especially helpful for irritated skin. This is ground oats that are soaked in liquid to help the skin absorb it more easily. This wonder product contains vitamin E, anti-inflammatory properties, phenols, and starches, among many other benefits (7).
Add a couple of tablespoons to a lukewarm bath and let your baby soak for ten minutes. Rinse off with a bit of water and apply your preferred lotion.
When to See a Doctor
Usually, there is no need to seek medical advice. Peeling and dry skin happens to most new babies and will stop once the new layer of skin is exposed. Still, there are a few signs to look out for.
If you spot any of the symptoms below, contact your pediatrician.
- Sudden redness that doesn’t go away.
- Cracked skin (fissures).
- Persistent dry patches.
Restore Your Newborn’s Dry Skin
Dry skin or peeling skin is entirely normal in newborn babies. It often affects overdue babies since they had less vernix to protect them during the last few weeks before delivery. If it continues or causes irritation, it could be due to infant eczema.
Keep your baby hydrated and their skin moisturized with lotion. Use a humidifier in the room, and minimize exposure to cold air. This should help resolve the problem. Remember the red flag signs of redness, swelling, or itchiness, and call your pediatrician if these are present.