Eczema and Baby

Concerned about dry, itchy, red spots on your infant? It could possibly be eczema. This blog entry will tell you more about eczema and how to help your infant cope with it.

• What is Eczema?

Eczema is a chronic itchy skin condition. Eczema usually starts within the first five years of life, most often in the first six months. It typically lasts into childhood and adolescence. In some cases it may last into adulthood. Eczema tends to wax and wane. There are periods of time where the skin appears mildly affected or even normal, alternating with periods of moderate to severe involvement. Some children have very mild eczema and others have severe eczema (also known as atopic dermatitis).

Eczema tends to be more common in families that have a history of eczema, hay fever, and asthma. These disorders are all a part of what is called the “atopic triad.” A first or second degree relative with a history of one of these atopic conditions can often be identified in the family of a child with eczema. Children with eczema may be more likely to develop allergies or asthma but one does not cause the other.

• What can trigger eczema?

Eczema flares occur when the skin is very dry, it comes in contact with irritating substances or allergic triggers, or when the skin is infected. Eczema tends to be worse in the winter when the air is dry and tends to improve in the summer when it is more humid. In babies, saliva from drooling may cause additional irritation, particularly to the cheeks, chin and neck. In such cases, applying an ointment like Aquaphor or Vaseline can prevent direct contact with saliva and decrease skin irritation. Specific triggers can vary based on the child and can include pets, carpet, dust mites, fabrics (such as wool), cigarette smoke, and scented products (such as perfume, laundry detergent and air freshener).
When the skin is infected your pediatrician or dermatologist may have to prescribe an oral antibiotic to improve the eczema.

• How do I treat eczema?

Unfortunately, there are no cures for eczema. Fortunately, in most children eczema becomes less severe with time. The good news is eczema can be controlled. Treating eczema requires treating both skin dryness and skin inflammation. A good bathing routine is necessary to treat skin dryness. Anti-inflammatory medications, like topical steroids or topical calcineurin inhibitors (TCIs), are used to treat inflammation. Occasionally, oral anti-inflammatory agents are needed to treat the most severe cases.

• Bathing a child with eczema

Daily bathing is recommended for infants and children with eczema. Baths are generally preferred over showers. Baths should be warm, not hot, and they should be short in duration, lasting about 10 minutes. The use of soap should be limited. Bubble bath, epson salts, and some other bath additives should be avoided because they can be irritating to the skin and worsen eczema. Also avoid the use of scrubbers, loofahs, and rough washcloths. Immediately after bathing, a moisturizer should be applied to the skin.

Dove© bar soap for sensitive skin, Stelatopia Cream Cleanser, Cetaphil© Gentle Skin Cleanser, and CeraVe© Hydrating Cleanser are examples of cleansers often recommended by dermatologists to treat eczema. Cleansers should only be used to wash the diaper area and areas that appear dirty. They do not need to be used on a daily basis.

• Moisturizing a child with eczema

 Moisturizers should be applied at least twice daily—in a thick layer. Generally two types of moisturizers are recommended for treating eczema: ointments and creams. Lotions are mostly water and are not recommended. It is most important to moisturize the skin immediately after bathing (within 3 minutes) to prevent evaporation of moisture from the skin. Ointments and creams seal moisture from the bath into the skin, much like plastic wraps seal moisture into a cake.

Moisturizers are classified based on their oil and water content. The more oil a moisturizer has the more effective it is in treating dry skin. Ointments have the greatest oil content, followed by creams, and then lotions. Creams and lotions also often have added preservatives that may burn when applied to scratched open skin. Ointments usually do not burn when applied. Ointment-based emollients and medications are generally preferred over creams for these reasons. Lotions are not generally recommended. During the summer a cream may be preferable to an ointment to prevent miliaria (prickly heat), which can occur after application of an ointment in the summer heat and humidity.

To prevent skin irritation, seek out moisturizers that are fragrance- and dye-free.

• Shampooing a child with eczema

Most gentle baby shampoos can be used. Fragrance- and dye-free shampoos are preferred. The fewer the ingredients, the better. One example is Exederm™ Baby Eczema Shampoo. 

• Will changing my child's diet help?

While many parents assume that a particular food is the cause of their child’s eczema, the answer is rarely that simple. Most eczema is unrelated to diet. In fact, parents who remove food from their child’s diet in an effort to clear up the skin can be causing more harm than good. If your child’s eczema greatly improves with gentle skin care and topical medications as described above, it is unlikely that there is a “hidden” food allergy in play.

Some children with eczema have food allergies, but that does not mean that the food allergies actually cause the eczema. If your child gets hives (red, itchy swollen skin bumps that look different from eczema) within one hour of eating a specific food, this is a sign of a food allergy and this food should be avoided until you talk to your child’s doctor.

Most infant eczema is unrelated to diet, whether breast milk or formula. Many babies with eczema are incorrectly labeled as “milk allergic.” Do not stop breastfeeding or giving cow’s milk formula without first talking to your child’s doctor. In most cases the skin will improve by using the gentle skin care techniques and topical medications described above.

Sources: National Eczema