Baby Eczema – the signs and the treatments…

Babies often get red, scaly skin known as eczema.

Eczema is the name for a group of conditions that cause the skin to become red, itchy and inflamed. Over 30 million Americans have some form of eczema. The most common form of eczema is Atopic Dermatitis. Though eczema can appear anywhere on the body, common body sites are the hands and feet, the inside bend of the elbows, behind the knees, and around the ankles and wrists. Eczema can also appear on the face, particularly the cheeks, and on the neck and upper chest. The skin around the eyes, including eyelids, may also be affected. The diaper area is usually spared. Scratching can cause redness and swelling and further worsening of symptoms, particularly itch.

Your baby may scratch the itchy patches and the eczema can get infected as a result – but what can you do to help your baby and minimise discomfort.

We talk to Dr Stefanie, Dermatologist and expert in baby skincare to find out more…

How long does baby eczema usually last?

You’ll be glad to hear that most children will outgrow eczema before they start school. However, in some children is lasts until puberty (when the skin’s oil glands naturally become more active, which is helpful for eczema prone skin) and although not common, some patients will take eczema into adulthood. There are times when the condition gets worse (flare-ups), followed by times when the skin heals, during these times there may be no signs of eczema or just dry skin visible (called remission). Sometimes a flare up can be due to certain environmental and/or lifestyle triggers such as winter or stress, but often no cause can be identified. It’s important to note that even in remission phases, the skin needs daily application of emollients – this is to lower the frequency and severity of flare-ups. More about that below.

What causes it?

Atopic eczema is a complex condition caused by a number of factors including impairment of the skin’s barrier function as well overly reactive inflammatory responses and tendency for allergies. Eczema tends to run in families so if one or both parents have eczema, a baby is a lot more likely to get it too. That’s because eczema is essentially caused by a genetic predisposition (ie is part of your genes). In addition to this genetic predisposition, certain lifestyle and environmental factors may aggravate the condition or trigger flare-ups, see below. Eczema (as well as heyfever, asthma and allergies) belongs to a group of conditions called ‘atopic’. So, if there are any atopic diseases in the family, the baby is more likely to develop eczema.

Alterations in genes important for maintaining a good skin barrier function have been linked to the development of eczema. Amongst other factors, eczema skin has a lower content of certain lipids such as ceramides. If you don’t have enough of these, the skin’s barrier function is suboptimal (ie the skin can’t hold water very well), which means that your skin will lose more water via evaporation than normal. This in turn means the water content of the skin’s (upper) horny layer (known as stratum corneum) is too low, which makes the skin dry.

The impaired barrier function in eczema skin also makes the skin more susceptible to germs as well as irritating and allergy-causing (‘allergenic’) substances to enter the skin.

There is also inflammation in the skin due to changes in the skin’s complex immune system.

The skin’s microbiome (the large group of bacteria living on our skin) is also changed in eczema sufferers.

Eczema is not infectious and cannot be caught from somebody else.

Is there anything a mother can do in her diet to reduce this?

Some evidence supports the idea that the risk of baby eczema can be reduced by exclusive breast-feeding for a full 4 months, and by taking probiotics during pregnancy. Probiotics are live ‘good’ bacteria in certain supplements, live yogurts and fermented foods. The right balance of good bacteria in our body helps our digestion, immune system and various other body functions. There have also been suggestions that eating oily fish or taking fish oil supplements during pregnancy may help prevent baby eczema. However, the final jury on all of the above is still out.

Where does it commonly appear?

In young babies, eczema is often located on convex skin areas such as the cheeks, whereas in later childhood, the eczema gradually moves onto concave skin areas such as in the inner elbows and behind the knees. Behind the ears and on the neck are also common locations.

The symptoms of eczema are itchy patches of red, dry, flaky skin. Over time the skin may become thickened from scratching (this is called lichenification) and cracked. It feels very itchy and uncomfortable.

On palms and sides of the fingers, eczema may appear with tiny blisters.

Very active (‘acute’) eczema may become moist and weep clear fluid.

Approximately one third of children with eczema will also develop asthma and/or hay fever.

What aggravates it?

Environmental factors including contact with certain soap, bubble baths, detergents and other chemicals applied to the skin, can all aggravate eczema. Fragrances and perfumed toiletries may also aggravate eczema in some children.

Other factors that may trigger a flare-up or aggravate eczema are being around animals, urban pollution, heat, cold, dry air, dust, and woolly or scratchy fabrics (smooth cotton is better). Phycological stress can also make eczema worse, as does chlorinated swimming pool water.

You should try to keep your child’s bedroom cool at night, as getting hot and sweaty whilst asleep can make eczema worse and result in scratching. Baths should also be kept short and luke warm.

Being unwell, for example having a cold or the flu, or simply teething can also cause a flare-up.

Exposure to allergens such as certain natural substances (eg calendula, a common allergen), as well as infection with certain bacteria and viruses, may also aggravate eczema. In some, food allergens may cause a flare up, but this is less common than generally thought.

One very important factor that can make eczema worse is dryness of the skin. This is why daily application of emollients, even in between flare-ups, is so important.

How do you stop a baby from scratching?

It’s important to try and keep your baby from scratching their itchy skin as much as possible throughout the day, but also at night, as scratching can make the eczema worse and causes the skin to get thicker and more leathery in appearance, also known as lichenification (it’s a vicious circle).

Scratching can also lead to a secondary skin infection, which could appear as weepy skin with yellow crusts.

It’s near impossible to stop babies from scratching, especially at night, so investing in scratch mittens or cotton pyjamas with inbuild mittens is an important step for night-time.

Cotton bandages and/or cotton or silk pyjamas can also help to prevent baby scratching. Sometimes these may be applied as ‘wet wraps’ on top of emollients, which can be useful for short periods, but please get your GP’s nurse to talk you through this carefully!

Also, trim baby nails often, keep them short, and take the edge off of them with a file if you can, so scratching damages the skin less.

Once the child gets older, teach them to scratch with their knuckles instead of fingernails (ie make a fist, tuck in the thumb underneath, and scratch with the knuckles), as this is less damaging to the skin. As it’s near impossible to stop children from scratching altogether, this way you empower them to scratch in a less damaging manner. It works surprisingly well in my experience.

Emollients applied regularly will also reduce scratching. These can be applied repeatedly throughout the day and are very helpful. Another tip for slightly older children (it may upset babies) is to keep the emollient in the fridge, so it refreshes the skin when applied, which calms itchiness for a little while.

Your doctor can help with antihistamines (certain ones can also help baby sleep) and anti-inflammatory creams, which reduce the need to scratch.

What’s the best treatment process (day and night)?

Treatment depends on the stage of the eczema. If the eczema is flared with inflamed patches, a short course of topical steroids or calcineurin inhibitors (a newer type of steroid-free, anti-inflammatory creams licensed for children from 2 years onwards) is necessary to break the vicious circle. It’s important to treat flare-up swiftly, as otherwise you may end up having to use these anti-inflammatory creams for much longer periods. I know steroids have a bad reputation, but a short course under medical supervision is usually very well tolerated well without any side effects and is an important part of eczema treatment. It’s only if topical steroids are used for too long periods that they can cause issues such as thinning of the skin. Please listen to your doctor and their recommendation.

In addition (and also as maintenance in between flare ups!), regular application of emollients is crucial in order to support the skin’s barrier function and hydrate the skin. This may need to be done multiple times per day.

Although we can’t currently cure eczema, a combination of daily emollients, moisturizing baths, avoidance of irritants, and intermittent use of anti-inflammatory creams, can keep the symptoms in check until the child eventually grows out of it, as most thankfully do.

A very good emollient for eczema prone skin is the Dermexa range from AVEENO® Baby. This is formulated not only with beneficial ceramides, but also with an oat complex, made up of oat essence and colloidal oatmeal. This combination of ingredients helps fortify the skin’s natural barrier function, locks in moisture and has calming benefits.

The Dermexa range offers a full routine to care for baby eczema – use the AVEENO® Baby Dermexa Moisturising Wash in a lukewarm bath (hot baths should be avoided in eczema prone skin), followed by the AVEENO® Baby Dermexa Daily Emollient Cream to help skin moisturised and also prevent dryness from reappearing. For bedtime, you could use the richer AVEENO® Baby Dermexa Goodnight Emollient Balm. This can of course also be used during the day in particularly dry areas.

Please do not use Aqueous cream as a leave-on product, as this was originally developed as a soap substitute and can irritate the skin and make eczema worse!

I also strongly recommend not to use ‘natural’ herbal creams, as they often cause allergic reactions over time. Also, some so-called ‘natural’ creams available online have been shown to contain very potent steroids that are unsuitable for baby skin.

Bacterial infection (often with a bacterium called staphylococcus) making the affected skin look yellow and crusty, needs specific anti-bacterial treatment from your doctor. An infection with the cold sore virus herpes simplex (herpetic eczema) can cause a sudden widespread flare-up of eczema with weeping tiny blisters and sores. This needs emergency treatment.

Measures to reduce dust and dust mites in the house, especially in baby’s bedroom, may also be helpful. This may include removing soft toys from the bed (putting them into the freezer for 48, followed by a machine wash, will also reduce dust mites), replacing curtains with wet-wipeable blinds, and replacing carpets with wet-wipeable flooring. An special anti-allergy cover for mattress and duvet may also be worth considering.

When do you seek further medical help?

I recommend to the call if your baby’s eczema doesn’t begin to get better within a week of starting over-the-counter emollients, as it may be time for a prescription cream.

Also check in with your doctor if yellow or light brown crust or pus-filled blisters appear on top of the eczema as this could be the sign of a bacterial infection that needs antibiotics.

Last, but not least, if you baby suddenly develops a widespread rash of tiny blisters and sores, see your doctor urgently or go to A&E, as this may be herpetic eczema, which needs anti-viral treatment.