Let’s Talk About Eczema in Babies
I see babies and kids in the office every day with eczema and dry patches of skin. We call inflamed or irritated skin dermatitis.
Eczema can occur at any age, but it most frequently occurs in babies. Eczema or atopic dermatitis is dry, inflamed, itchy skin. Though some babies with eczema also have asthma or allergies, a triad that leads us to call the child ‘atopic,’ most babies or kids with eczema do not have allergies or asthma. Though we are unaware of a specific cure for eczema (no, sorry, changing your child’s diet likely won’t lead to much change in their skin condition), there are lots of things you can do to help improve the skin and minimize itching.
What causes eczema in babies?
The exact cause of eczema is unknown. Research does show that genetics play a role, and we do see that parents with eczema are more likely to have children with eczema. Not all babies with eczema have a family history, though, and not all parents with eczema have babies with eczema. It’s a correlation, not causation.
The genetic variation likely disturbs the skin’s integrity, making your baby’s skin vulnerable to allergens and irritants. Healthy, normal skin retains moisture and protects against bacteria, viruses, and irritants. More sensitive eczema-prone skin is more vulnerable to these exposures.
What are the most common triggers of eczema in babies?
The most common triggers of eczema which I have found are:
- Use of synthetic fabrics (as opposed to gentle cotton)
- Wearing scratchy or irritating material like wool
- Excessive sweating or having wet skin
- Friction on the skin
- Certain chemicals and detergents that irritate the skin
- A drop in humidity or air dryness
- Change in temperature from cold to hot or hot to cold
- Contact with animal dander if baby has an allergy to animal dander
- Food allergies
What are the types of eczema or types of dermatitis?
Although there are seven distinct types of eczema (or types of dermatitis), four different types of eczema are most common in babies.
The most frequently occurring type of eczema is atopic dermatitis. Atopic dermatitis is characterized by itchy and dry skin, often appearing as a red, irritated rash.
Other types of eczema are:
Contact dermatitis is caused by irritant exposure. Burning, redness, and itching develop. The skin may even swell. The rash improves when the triggering agent is removed.
This type of dermatitis affects the hands, on the palms, fingers, and foot soles. Itchy, scaly patches appear, which either become red, cracked, or causes pain. This condition is most frequent among women.
This condition is known as cradle cap. What is cradle cap? Seborrheic dermatitis most commonly affects the scalp and eyebrow area. The cradle cap leads to patches with a yellow scale. There may be underlying redness and atopic dermatitis.
Do we see different types of dermatitis at different ages?
The types of eczema we see in babies and children do change as they age. Not only does the type of dermatitis change as kids grow up, but the location varies as well.
Babies less than six months
Young children most typically have eczema on ‘extensor surfaces’ or outer surfaces of the skin (versus flexural surfaces such as behind the knees or elbow creases). In young babies, eczema is most common on the face. Eczema on the face is most often on the cheeks, chin, scalp, and forehead. Eczema can also spread to other body areas; eczema doesn’t always appear in the same location. Face eczema will be more red, rough, and dry than the rest of the skin.
Babies 6-12 months of age
Though infants most commonly have eczema on their face, eczema can be widespread, from head to toe. Eczema can appear on the chest, back, legs or arms, and they now have reached the developmental milestones that allow them to scratch more easily. If somehow that skin area becomes infected, you may see crusty or weeping skin or expanding redness on the skin around eczema.
As children get older, eczema can start to appear on ‘flexural surfaces,’ such as behind the knees or elbows, on the ankles, hands, and wrists. Some children have eczema around their lips or eyelids. Your child’s skin will be dry and scaly, red and inflamed.
Eczema can appear anywhere on the body, but most typically are seen in elbow creases, behind the knees, and on the hands. Many kids have atopic dermatitis behind the ears, on the scalp, or chest, but it can appear anywhere on the skin.
Eczema treatment in babies and how to prevent dermatitis
• Keep your baby’s skin well moisturized even in the absence of rash.
• Every diaper change, or whenever you remember, apply lotions, creams, or ointments to moisturize, ideally at least twice a day.
• Before trying any new moisturizer, use it on a small portion of the skin to make sure that it does not trigger eczema or worsen the condition.
• Consider using something ‘greasy’ like petroleum jelly, or petroleum-free jelly, which lubricates and moisturizes the skin to prevent and treat eczema in babies.
• When bathing, looks for moisturizing, gentle soaps.
• Do not use antibacterial or deodorant soaps as this can further exacerbate eczema and removes natural body oils.
• Try to take shorter baths. Limit the bathing time to 10 to 15 minutes. Avoid warm water, as this can dry out the skin even more.
• After bathing, dry the baby’s skin with a soft towel and apply a moisturizer. Pat dry as opposed to rubbing.
• If you notice that when the baby has a particular food, eczema worsens, talk to your doctor. This can be from any food, but milk, eggs, wheat, peanuts, tree nuts, fish and seafood, and soy, are the most common allergens. Children with allergies are at more risk of developing eczema. Remember, most kids with eczema do not have food allergies.
What pregnant mothers should do to reduce eczema risk
Many mothers ask me if they should avoid eating certain foods when pregnant or once a baby is born. Research has shown that restricting allergens from mom’s diet does not decrease eczema risk. Research recommends that eating healthy foods during pregnancy and breastfeeding like fish, fruits, nuts, and eggs can help prevent eczema risk. Always review your diet with your doctor should you have any concerns or questions.
If you notice the rash spreading or your child has other symptoms such as facial swelling, difficulty breathing, or gastrointestinal symptoms like vomiting, seek medical attention.