Does the skin on your precious newborn appear dry and peeling?
Dry skin and peeling are two common side effects of residing in fluid for nine months.
Remember the saying “soft as a baby’s bottom?” The truth, however, 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.
Causes of Dry Skin in Babies
The main culprit for dry, peeling skin is exposure to the amniotic fluid. Your newborn spent months surrounded by this liquid. Typically, this can affect 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 normal, smooth skin. Many of my parents ask me about using moisturizers in an effort to reduce peeling. I reassure them that moisturizers are unnecessary, and the skin peeling 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, vernix caseosa, forms to protect it from the various liquids.
What Is Vernix Caseosa?
Around the 17th to 20th week of pregnancy, something incredible happens. 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 a two-way protection. The water prevents skin dryness, and the lipids block the surrounding fluids from direct contact with the skin. It’s just incredible how it all works, isn’t it?
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, after five days, or when your baby has their first bath, the vernix disappears. This can trigger an avalanche of skin shedding.
The most shedding typically occurs within the first two to three weeks. This is when the 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 may ooze if scratched which increases the possibility of infection. On the contrary, seborrhea tends to start on the scalp, then spread down the body in more severe cases. The rash tends to be oily and look like dandruff and, occasionally, with 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. Some possible triggers for flare-ups are:
- Dry skin.
- Irritants: Scratchy clothing, perfumes, and laundry soaps.
- Heat and sweat.
- Stress: This leads to flushing, which can cause irritation.
- Allergens: Dairy, soy or wheat, among others, can be a trigger.
I have seen a few infants with mild eczema which worsened when oat cereal was introduced as one of the first foods. When I inquired as to which skin products the parent was using, it happened to be a colloidal oat-based moisturizer. Once both the oat cereal and that particular moisturizer were discontinued, the eczema resolved.
Editor's Note:Dr. Leah Alexander, MD, FAAP
Why Does My Newborn Have Eczema?
There are a couple of reasons why your newborn developed eczema. Usually, it’s because it runs in the family. If either Mom or Dad had this condition, other allergies, or asthma growing up, the likelihood of your baby having the same 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 which help our skin retain moisture. When the body fails to generate enough of these fatty cells, the skin becomes dry.
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 ointment 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 causing dry, peeling skin which 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, affecting 1 in every 250 people. If you have it, there is a 50 percent 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 the mouth. It might appear cracked or peeling. The skin on the chest or torso will likely seem taut, as if it’s being stretched.
If hair is present at birth, it might look like stubble, as opposed to the usual smooth strands. Eyebrows and eyelashes may also be missing.
Sometimes, those with ichthyosis will also have eczema. This typically leads to worse flare-ups, and may continue into adulthood.
Triggers can include:
- Cold or dry air.
- Scented soaps and perfumes.
- Long 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 which connects keratin fibers to epithelial cells.
Filaggrin creates a natural barrier for the skin, to maintain healthy levels of moisture and pH. Without this barrier, the skin fights to retain moisture.
Then, as the dehydrated cells age, they begin to harden and thicken. Eventually, they move to the surface of the skin where they appear as fixed scales.
“Sermin Perinatology” gives additional details about this condition.
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
If your newborn has dry skin, avoid long baths. Soaking in the baby tub can deprive the skin of its natural oils, promoting dryness. Of course, stick to sponge baths until the umbilical cord is off.
Keep bath time under ten minutes, two to three times a week — avoid giving a daily bath for now. Additionally, use lukewarm water as opposed to hot, and only use a mild soap.
For newborns, you really 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 of course 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 the oil. It was a bonding time for us and we both loved it.
My advice is to 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 to the skin, so cover your baby’s hands and feet when you go outside. You can place a loose cover over the carrier to protect the face. Just ensure there are no choking hazards and use a breathable fabric.
4. Cut Out Unnecessary Chemicals
Many chemicals in skincare 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 special soaps or laundry detergent, which are milder 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 baby’s eyes, but it will soften and moisturize the skin without harsh perfumes.
You could also try washing your clothes with the 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, gentle on clothes for sensitive skin.
5. Stay Hydrated
Make sure your baby stays hydrated. For now, breast milk or formula is enough. From six months up, 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, but especially if your little one has eczema or extremely dry skin.
In particular, colloidal oatmeal. This is ground oats, soaked in liquid to help the skin absorb it more easily. This wonder ingredient holds 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 little 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, which doesn’t go away.
- Cracked skin (fissures).
- Persistent dry patches.
Restore Your Newborn’s Dry Skin
Dry skin, or peeling, is entirely normal in newborn babies. It more 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, before calling the pediatrician.