Q:

12/5/2013
I have a 4 months of age baby boy who first came to me at his early newborn period with a body rash. Basically he was red all over and the history given was that mom gave him a bottle of formula instead of nursing and this is what happened. The boy seemed to feel fine and his examination was normal apart from this red rash. It disappeared over night and mom was advised to exclusively breast feed. Father has history of shell fish allergy and his two other siblings from another mother have severe eczema.

Soon after, the mother came back with another flare up all over his body. This time his skin was quite dry and we couldn't relate to anything specific except that the mom had eaten fish and it might have been a contributor to the rash. I advised moisturizing and very low dose of cortisone cream which seems to calm the rash down.

I last saw him at the age of 4 months when he developed a rash after receiving vaccinations. His body turned red and he had a slight swollen right eye. Otherwise he was well. The rash subsided with the some residual scales. I haven't seen this type of total body flare ups before in infancy and he never seems to be unhappy or does he itch. But now with this happening after vaccination I am worried about what is next to come on his 6 months vaccine and what would the cell memory bring. His CBC and total Eosinphils were normal and total IgE was normal.

Are these skin flares common or should I be worried about a more serious problem? What would be the best thing to do for this next vaccination?

A:

Thank you for your inquiry.

I am referring your inquiry to Dr. Michael Blaiss. As soon as we receive his response, we will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Blaiss. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Michael Blaiss:
This is definitely a perplexing problem when dealing with infantile rashes. It sounds like the child may be having flareups of atopic dermatitis which can definitely start at this age especially with the strong family history of atopy. What you describe is a rash that comes and goes and leaves scaling. Also the child has dry skin. Otherwise the child appears to be healthy. At 4 months, I don't always notice significant pruritus. Along with mild hydrocortisone cream and moisturizing, I would make sure that a fragrance free detergent is used for the clothing and a "hypoallergenic" soap for cleaning.

Since the episode after the 4 month vaccination was one to two days later, it does not sound like an IgE mediated reaction to the vaccine. If you want to be on the safe side, you might give it in a split dose as we used to do for flu vaccine in egg allergic children. In other words, 1/10 of the vaccine and wait 30 years, and then give the other 9/10 and observe for another 30 minutes for any reaction.

I hope that helps.

Sincerely,
Michael S. Blaiss, MD

AAAAI - American Academy of Allergy Asthma & Immunology