An 18-day-old male neonate was brought in to our Emergency Department with concern about a large dark rash around the umbilicus with an area of desquamation (Fig. 1). He had otherwise been acting normally with normal intake and output, and no fever. The umbilical cord had fallen off three days earlier, and silver nitrate was applied to stop the bleeding. After rash developed, bacitracin was applied and the newborn was referred to the burn clinic. The lesion healed completely with some residual hyperpigmentation.

Fig. 1. Chemical burn around umbilicus in a neonate.

It is important to keep the cord stump dry and not to cover the area with diaper as occlusive dressing will disperse the chemical and cause burn. Also, protecting the surrounding skin with petroleum jelly is recommended. The differential diagnoses for this condition include heat burn and focal allergic reaction. The provider should also consider possible child abuse when evaluating infants with burns.