Blueberry Muffin Rash on Babies: How to Recognize and Treat

Blueberry muffin rashes on babies involve blue, purple, red, or gray spots that are widespread on the body, face, and extremities.

The term often links to congenital rubella, but blueberry muffin rashes may have other causes.

Let’s take a look at what a blueberry rash on a baby might look like, what might cause it, when to contact the doctor for a diagnosis, and how doctors can treat these rashes.

What is blueberry muffin syndrome?

Doctors first used the term “blueberry muffin rash” in the 1960s during an epidemic of rubella among newborns. Doctors noticed that babies with rubella developed rashes that resembled blueberry muffins.

Although these types of rashes are rare in newborns, it’s possible that a pregnant person with rubella can pass this infection along to their baby. Babies who get rubella while in the womb may experience a combination of symptoms after birth, including a blueberry muffin type of rash.

Why does this happen in babies?

A baby getting rubella while in the womb is a common cause of blueberry muffin rash.

What is congenital rubella?

Congenital rubella syndrome is a condition that newborns can get when their birthing parent has rubella and passes it to them during the pregnancy. Congenital rubella can be serious and increases the risk of miscarriage, stillbirth, and developmental issues for a fetus.

The risks of serious impacts are highest during the first trimester of pregnancy. Rubella is preventable through vaccination of the birthing parent.

But since the time doctors coined the term “blueberry muffin rash,” doctors and medical researchers discovered that other conditions in newborns can also cause blueberry muffin rash.

These conditions may include:

• TORCH syndrome, an acronym referring to toxoplasmosis, others, rubella, cytomegalovirus, and herpes that babies can get while in the womb
• extramedullary hematopoiesis, which is when blood cells from bone marrow grow in various parts of the body
• vascular anomalies, or birthmarks
• twin-to-twin transfusion syndrome
• haemolytic disease, a blood disorder that occurs when the blood type of the birthing parent and baby don’t match
• hereditary spherocytosis, a genetic blood disorder
• certain pediatric cancers, such as leukemia, neuroblastoma, and rhabdomyosarcoma

What can parents look for in their babies?

Babies with blueberry muffin rashes will have bluish, purplish, or reddish spots all over their bodies, which often cause them to resemble a blueberry muffin. The spots can also be gray or magenta. The color of the spots may depend on your baby’s skin color and the particular condition causing the spots.

The spots are nonblanchable, which means that they don’t turn white or disappear when you press on them. The spots are also maculopapular in nature, meaning that they can be both flat and slightly raised.

Other symptoms

Besides a rash that resembles a blueberry muffin, other symptoms your baby might experience will differ depending on what condition causes the rash.

Always be in touch with your pediatrician if your baby has a new rash or other concerning health symptoms, such as

• fever
• lethargy
• extreme fussiness
• trouble breathing
• vomiting
• diarrhea

In the case of congenital rubella, babies may have symptoms that include various organs, including the skin. Some of these symptoms may include:

• cataracts
• newborn glaucoma
• heart disease
• unusually small eyeballs, which is called microphthalmia
• hearing loss
• intellectual disability
• decreased blood platelets, which is called thrombocytopenic purpura
• enlarged liver
• jaundice
• structural changes in the bones
• rashes, including blueberry muffin rash

When should you contact a doctor

It’s common for newborns to get all kinds of rashes, and it’s equally common for parents to have concerns about these rashes.

Most rashes are harmless and go away on their own.

Still, babies usually need an examination from a healthcare professional if a new rash emerges. If your baby has symptoms of a blueberry muffin rash, contact a pediatrician for a diagnosis and treatment plan.

Treatment

Treatment for blueberry muffin rash will depend on the underlying condition causing the rash in your baby. When it comes to treating rubella, there is currently no treatment or medication for newborns. Instead, doctors usually recommend supportive care, such as rest and hydration.

Newborns with rubella may have the infection for up to a year. Doctors recommend isolation during this time to help avoid passing on the infection to others.

Doctors may test babies periodically starting at 3 months until the infection clears. It is important to carry out proper hygiene, including handwashing, when in close physical contact with a baby who has rubella.

Can you prevent blueberry muffin rash from happening?

When it comes to preventing rubella in infants, vaccination can be key.

Doctors usually administer the measles, mumps, rubella (MMR) vaccine to people in their childhood. It can be highly effective at preventing rubella infections. After one dose of the vaccine, the antibody response is 95%. It rises to 100% after two doses.

Getting a vaccine against rubella can prevent you from getting the infection and then passing the infection to your baby during pregnancy.

If you have not received an MMMR or are unsure if you have, talk with your doctor.

Because MMR is a live vaccine, you can’t get it during pregnancy. You can get the vaccine before you become pregnant, or afterward. If you are unvaccinated and pregnant, taking precautions to avoid infection, such as handwashing and avoiding close physical contact with people who are sick, can decrease your risk.

Outlook

Your baby’s outlook for blueberry muffin rash depends on the cause. Many of the causes of blueberry muffin rash are treatable, but some are serious conditions that may require extensive medical care.

If your baby has a medical condition that causes their rash, your healthcare professional will talk you through the steps necessary to treat the condition.

The outlook for congenital rubella depends on the seriousness of your baby’s structural changes and the timing of the infection. Infection during the first 18 weeks or so of pregnancy increases a baby’s risk of serious structural changes.

If you pass the infection on to your baby after 18 weeks, the chances of serious structural changes decrease. Some babies may get rubella during this time but show no symptoms at all.

There is little data on the correlation between blueberry muffin rash and serious illness. A 2015 case report noted that the severity of illness among babies with blueberry muffin rash linked to rubella varies but often indicates a worse outlook.

Takeaway

It’s understandable if you feel stressed or panicked when you see a new rash on your baby.

If you notice blue or purplish spots that cause your baby to resemble a blueberry muffin, make sure to discuss this with your pediatrician as soon as possible. But blueberry muffin rashes are rare, and the conditions that may cause these rashes are also rare.

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