Baby eczema is a condition that occurs in children below the age of two. Around one-in-five babies are affected by eczema, but in a majority of the cases, the child will outgrow the condition by the time they become a teenager. Although there is no cure for baby eczema, with the right treatment the condition can be kept under control.
Also called atopic eczema and atopic dermatitis, baby eczema is actually an inherited disease like asthma and hay fever. The disease results in red, cracked, itchy and dry skin that may on occasions ooze blood and fluid. Found commonly in areas like neck, face, hands, back of knees and elbows, the condition indicates a defect in skin’s function as a barrier. The skin is more susceptible to allergens and infections due to this condition and this exacerbates the symptoms.
Symptoms
Baby eczema waxes and wanes in intervals with periods in between where the skin looks normal. While in some the symptoms are mild, others can exhibit severe eczema. The appearance and areas where the eczema occurs is also altered as the child grows. In very young babies, it is concentrated in the scalp, forehead and cheek region. Except the diaper-covered area, it can occur most other all regions as well.
During six to twelve months of age, when babies start to crawl, the eczema is seen in knees and elbow region. At two years of age, the condition is seen in knees, elbows, ankles, hands and wrists. Eyelids and skin around mouth may also be affected. In older children up to adolescent age, the condition may be limited to just hands. While in babies, the condition manifests as weepy and red, and later becomes dry, and the skin is thickened with lines showing prominently in what is called as lichenification.
Flare-ups of eczema are seen when the skin is dry and there are allergic or irritating substances that trigger a reaction. The condition worsens in winter when the air is dry, but improves in summer, when there is more humidity. Even saliva drooling on the skin can cause irritation in babies in neck, chin and cheek regions. Applying Vaseline or other similar ointments can reduce the irritation.
Triggers vary depending on the child and include carpet, fabrics, pets, dust mites, cigarette smoke, air freshener, perfume or other scented products like laundry detergent. A pediatrician or skin specialist may prescribe antibiotics to help treat the condition.
Treatments for Baby Eczema
While there is no permanent cure for baby eczema, its severity wanes with time and its symptoms can be kept under control.
Moisturizers
The treatment depends on severity of the condition. If the condition is mild with just a few itchy and red areas, an emollient cream, ointment or lotion is sufficient. This may at times be combined with a steroid cream of low strength. The moisture produced by the creams and lotions help in preventing the eczema from flaring up.
Emollients, which soften and relax the skin, should be used liberally several times a day, even if the patches are not present. This avoids the skin from becoming dry. There are several types of emollients present from which a suitable lotion, bath additive or cream can be selected. Aqueous cream emollient should be avoided, as it irritates the skin.
Steroids
Most often in severe cases of eczema, doctors recommend treatment with ointments, steroid creams or emollients. While steroid creams are deemed unnecessary because of the side effects they produce, they are safe, when used in the correct way. Thinning of skin is the main side effect caused by prolonged use of steroids. Using the right concentration of steroid is important and it should be taken under strict supervision of the doctor. The cream should be applied only in the affected areas for maximum two times a day.
Oral Antihistamines
Antihistamines are prescribed in some cases of baby eczema, when the itching and irritation is severe, disturbing the baby’s sleep. But these medications are not used in routine eczema treatment. Most often, they lead to drowsiness, and should be used only at nighttime. When used, these should be given only under the advice of your doctor.
General Treatment Methods
The treatment used includes a combination of drugs that act on the inflammation and dryness in the skin. For treating the dry skin, a proper bathing routine is necessary. For inflammation, medications like TCIs (topical calcineurin inhibitors) or topical steroids are given. Oral anti-inflammatory medications are also used in some cases.
If the eczema is severe, more potent steroid ointments or creams should be tried. If the child does not respond to the treatment, a dermatologist should be consulted for other advanced treatment methods. Dry bandages with wet wrapping, which involves using bandages, soaked in steroid cream or emollient, and wrapped on top with dry bandages, helps in the medicine getting absorbed into the skin.
The treatment used includes a combination of drugs that act on the inflammation and dryness in the skin. For treating the dry skin, a proper bathing routine is necessary. For inflammation, medications like TCIs (topical calcineurin inhibitors) or topical steroids are given. Oral anti-inflammatory medications are also used in some cases.
Eczema may be complicated by infection due to scratching of the eczema patches. If the skin is infected, it may bleed or leak fluid. Antibiotics are needed to clear the infection. If the infected area is only minimal, antibiotic cream is prescribed. For larger areas, oral antibiotics may be needed.
Bathing Routine
For babies and young children affected with eczema, bathing daily is recommended, and preferably baths rather than showers. Warm baths and of shorter duration for about 10 minutes should be used. Soaps should be used limitedly. Epsom salts, bubble bath and other bath additives should be avoided as they can worsen the condition or cause skin irritation. Scrubbers, rough washcloths and loofahs should also be avoided.
A moisturizer should be applied immediately after bathing. Cleansers made especially for sensitive skin like Stelatopia cream, Cetaphil or Dove can be used. They should be used only on the diaper area and the other regions, which appear dirty, and not on daily basis.
Breastfeeding and Food Control
Exclusive breastfeeding for the first four-to-six months will give the needed immunity to fight against the disease. Cow’s milk or formula may also trigger allergies in a baby. Hence, it is necessary to consult with the doctor for proper formula selection. Your doctor may recommend a soya-based milk formula, goat’s milk, or hydrolyzed protein formula, instead of traditional formulas.
While there is no solid proof that eating certain types of food can trigger baby eczema, it is safe to consult with your doctor if you suspect eating certain foods, while breastfeeding, triggers the reactions. Research suggests using probiotics in the form of food or supplements during pregnancy to avoid the child from developing the condition. However, this is not a proven fact.
Self-Help Preventative Measures
Here are some measures that can help in reducing the severity of baby eczema:
- Keep a record of the triggers that lead to the eczema formation will help in finding the right treatment method
- Exposure to particular types of foods may aggravate the condition. By avoiding such foods, flare-ups can be avoided. However, the diet should not be changed completely without consulting your doctor.
- It has been suggested that house dust mites can trigger eczema, but there is no proper evidence regarding this trigger factor.
- Synthetic and woolen fibers may be too warm causing a worsening of the condition in your baby. Cotton clothes should be used in such cases.
- Bedding and babies’ clothes should be layered and light to enable adjusting the temperature easily
- Baby’s nails should be cut short to prevent damage when scratching.
- New clothes should be washed before using them to remove chemicals that were used during the manufacturing process.
- Avoid using scented or perfumed lotions and bubble baths
- Mild detergents, free of chemical dyes, should be used for washing clothes and rinsed thoroughly to remove the detergent completely.
- A bath or shower should be given, when the child plays outdoors in grass or in the park to remove allergens.
- Humidity in the house should be at 20-40 percent. A humidity gauge will help in monitoring the humidity. Air conditioning should be done to maintaining the right humidity level
Allergic Triggers
If the child has a history of food allergies, this can play a vital role in eczema triggers. Baby eczema is often a strong indicator of a food allergy, and babies with severe eczema usually have a food allergy as its trigger. About ten percent of baby eczema is caused by food allergies.
Studies reveal that babies with atopic eczema absorb food in a different way, as compared to those without the condition. This is one of the reasons why babies with eczema react poorly to certain foods. For babies with eczema, introduction of solid food should not be done until they reach 6 months of age.
There are some common foods, which are known to cause allergic reactions in children. Wheat, milk, soy, egg, peanuts, tomatoes, shellfish, yeast, tropical fruits and fish are the main foods. All these foods should be avoided for about three weeks. If a dramatic improvement is seen in the eczema, each food should be re-introduced individually to find out which one is the trigger food.
In some cases, the sensitivity may be triggered within two hours of eating the food. But usually, the food sensitivity symptoms are delayed until 24 hours after eating the food. Keeping a food diary will help your doctor decide on the right treatment. A dietician can help in balancing your baby’s diet if it’s determined that you must avoid certain foods.
Environmental factors
Environmental allergic factors include mold, dust, pets and pollens. These are more predominantly factors of conditions like asthma and nasal allergies, but can contribute to development of eczema in some cases. Therefore, it is necessary to identify and prevent these allergic factors.
Itchiness Control
The most critical issue in eczema is the persistent scratching and the itching sensation the condition causes. This is mainly due to dry and irritated skin. The scratching causes rash formation leading to flare-ups, which in turn cause more itchiness. To prevent this vicious cycle, the skin should be kept moisturized and the rash reduced, so the cycle could be broken. Some measures you can implement include:
- Keeping fingernails short and clean to prevent infection and trauma caused by long and sharp nails
- Keeping the child fully covered in pants and long sleeved shirt to prevent undue scratching
Using Medication (ALWAYS Check with Your Doctor)
Oral histamines including Benadryl (sedative antihistamine) and non-sedative drugs like Claritin, Allegra and Zyrtec can be used to help with baby eczema. While Zyrtec can be given to children two years and older, the other two drugs (Claritin and Allegra) have not been permitted for use in children under the age of two. These drugs are long acting and do not cause drowsiness in most cases, so can be used conveniently in daytime. Alternating between Benadryl at night and using a prescription drug during the day can be tried.
If the eczema is being controlled adequately, meaning the child is not showing any signs of itching or a rash, medication should not be given. When there are flare-ups, or a span of moderate or severe itching, the medication should be continued. These medications can be used for several weeks on a daily basis.
Topical application of steroid creams also controls itching in addition to treating the rash. The cream is available in varying strengths including extra strong, strong, medium and mild. If the rashes and itching are moderate to severe, the cortisone cream should be used on daily basis.
During flare-ups of mild, moderate and severe rashes, the treatment with cortisone involves:
- For mild rashes, over the counter hydrocortisone of 1 percent strength can be used twice in a day until the rash heals.
- For moderate rashes, where the area is inflamed and red and fluid or blood is oozing from the rash, a mild strength prescription of cortisone is needed to treat these rashes.
- In the most severe rashes, where the skin is red, irritated and oozes blood, a medium strength cortisone is needed to treat this condition.
Cortisone creams should be used until the rash subsides. The high strength cortisone creams should be used until the rashes are completely healed. Once the rash seems better, the stronger cream should be switched over to a weaker strength cream. This should be continued until the rash reaches baseline. The cream should be applied to skin while it is still damp after a bath. The cream should be applied first and then a moisturizer.
Side Effects of Cortisone
The long-term side effects of using cortisone cream include: thinning of skin, infections and stretch marks. Internal effects include change in hormone levels that can influence growth rate. Longer duration cream usage may lead to stronger side effects. Mild strength creams have only minimal side effects. It is the stronger strength creams, which produce the most adverse side effects, when used for long duration. The areas more susceptible to side effects include genital region, armpits and face. While mild and moderate strength creams can be used in these areas for a few weeks, strong creams should not be used.
Children suffering from eczema are prone to bacterial infections in the skin, especially in regions where the rash is worse. The infection termed as impetigo is characterized by increased skin redness and fluid that is honey colored, oozing and forming a crust on the rash. The infections are mostly due to Staph or herpes virus. You should get immediate medical attention for your child, if you find signs like increased fever, warmth or redness surrounding the affected region, fever blisters or cold sores in the skin, pus-filled regions in the affected area and worsening of the eczema.
Recommended Diet
Foods rich in Omega-3 fatty acids like flax seed or its oil, tuna fish and salmon should be added to daily diet. Vitamins C and E are rich in antioxidants offering good protection from infection and better immunity. Drinking fluids, especially water, helps in keeping the skin hydrated.
Even if eczema is bothersome for children and parents, by taking some precautions and following the orders of your doctor, you can keep the condition under control. Proper use of moisturizing lotions with petroleum-based creams in winter months, and lighter creams in the summer is effective for the itching and dryness. Natural products should be avoided, as the child may be allergic to flowers, fragrance or extracts. Using anti-itching creams and soft clothing for children also helps. Avoiding known allergic triggers like harsh detergents, fragrances and rough fabrics should be adhered to properly.
In most children, the condition improves during childhood, with only a minor percentage experiencing mild rashes and slight dry skin issues later on.
