Baby eczema: symptoms, treatment and advice
Eczema can be distressing for people of any age, but it's particularly stressful for parents of babies. We asked skin expert and dermatology nurse Julie Van Onselen to discuss the causes, symptoms and best ways to treat baby eczema.
What causes baby eczema?
Eczema can start at any age. It can be triggered by lots of factors, including viral infections.
Eczema can also be triggered by climate and temperature. Sudden changes of temperature, such as going from a centrally heated building into the cold, can aggravate eczema. Cold weather can cause skin dryness.
Central heating and less humidity in the winter can also be an irritant. As a general rule, a constant warm (but not too hot) temperature in a humid atmosphere is less irritating for eczema, so it’s more likely to be worse in the winter.
Eczema is a skin condition that also has ties to asthma, hay fever, and food allergies – because, according to the British Skin Foundation, they're 'all linked by an increased activity of the allergy side of the body’s immune system.' A study in 2009 at the Washington University School of Medicine found that, as the NHS reports: 'allergies and asthma often develop in the same people, and that 50-70% of children with atopic dermatitis (severe allergic skin problems) subsequently develop asthma.'
That's not to say that your child will develop asthma because they've had eczema, but it might be something to be aware of as they get older.
Symptoms of baby eczema
Eczema in babies causes patches of dry, red, itchy skin to appear on the face, in the creases of the knees, neck and elbows, or behind the ears. If your baby scratches these patches, the eczema can become infected. When this happens, a yellow crust or small bumps might appear on your baby’s skin.
In the first six months, eczema in babies tends to manifest on the face, chin, forehead, cheeks and scalp. It can, however, appear in other areas of the body. From six months onwards, eczema often appears on the elbows and knees.
The NHS states that children of Asian, black Caribbean or African descent may not experience eczema in the creases of the body, but it may appear elsewhere.
What about diet?
Diet as an aggravating factor in eczema is more common in children under two years than it is in adults. Saying that, you shouldn’t cut out important foods like wheat or eggs without discussing this with your GP first. – Dermatology nurse Julie Van Onselen
Food allergies can be a cause of eczema but you should always consult your doctor before making a change to your baby's diet. Just as eczema has ties to asthma, various studies have shown that it sometimes comes hand-in-hand with allergies. This is especially the case with babies.
The National Eczema Society explains the link as follows: “We know that babies with eczema in the first few months of life have an increased risk of developing a food allergy. The skin is a protective barrier and keeps bacteria, viruses and allergens out of the body. Those with eczema have a disturbance in this barrier, and we now believe that this disturbance is a route which allows allergens to enter and sensitise the body.”
The most common foods your child may be allergic to are:
- Dairy (milk and eggs)
- Nuts (especially peanuts and tree nuts)
- Fish and shellfish
If you think these foods are aggravating your baby's eczema, discuss your concerns with your doctor.
Should I restrict my baby's diet?
If you think that your child might be allergic to something in her diet, it's important to work with your doctor in testing whether this is the case. They might suggest that you remove a particular food from your baby's diet for a few days to see if the symptoms improve. For best results, make sure you only remove one food group at a time – that way you can make sure you know exactly which one may be causing your baby's eczema.
And don't forget that while getting rid of your baby's eczema might seem the priority, an overall healthy diet is essential both for your baby's general health and to stop their eczema from getting worse. So make sure you consult your doctor before changing things up.
Damp and mould can be another common eczema trigger. And genes, of course, may also play a role.
It can also be caused by skin irritation. Be careful about which shampoos, bubble baths and laundry detergents you use. You could opt for non-biological, fragrance-free laundry liquid and you may want to stick to emollients at bath time.
Since we switched to no fabric softener and a sensitive powder, my daughter’s only flare-up was when we visited my in-laws and used their normal powder. She’s bathed every day now, too.
What will alleviate baby eczema?
Emollients are often cited as an effective means of treating eczema, so it's worth noting that there are three different types. These are leave-on emollients, soap substitutes and bath additives. They can be prescribed on their own or, more commonly, in combination with each other.
There is some debate around whether bath additives are effective in treating eczema in babies, and some recent studies have undermined their usefulness. A trial published in the British Medical Journal found that emollient bath additives offer 'no meaningful benefit' in the treatment of eczema in babies and children when used alongside other eczema treatments.
The trial involved 483 children aged one to 11. They were split into two groups, with one using the bath emollient and the other not using it. Both groups continued with their usual eczema care routine, including using leave-on emollients.
Over the course of 16 weeks, both groups showed improvement in symptoms, with no difference in the level of improvement. There was also no significant difference between the groups in other areas, including how their eczema developed over one year, number of flare-ups in symptoms, and cost of treatment.
Should I use emollients for baby eczema?
Dr Miriam Santer, a GP and professor at Southampton University who led the study, said: “The bath additives don't work – basically you're pouring stuff down the plughole […] We don't need to tell people to put additives in their children's baths anymore, saving trouble for a lot of families.”
She also said that people should carry on using leave-on emollients and soap substitutes, as these are proven to be effective in treating eczema.
However dermatology nurse Julie Van Onselen said some parents and children still found them useful:
One very common myth is that daily baths are not good for eczema. The opposite is true, as a daily emollient bath will soothe eczema and help reduce itching. Emollients should always be used, and soaps/cosmetic washes and bubble bath avoided. This is what will aggravate eczema, and is the reason why this myth about daily bathing exists.
A daily emollient bath, on the other hand, will help cleanse the skin, reduce itching and repair the skin barrier, because emollients penetrate the skin. Remember to keep the water tepid, as too much heat can aggravate baby eczema.
In the cooler months, keep using emollients for washing and moisturising every day, even if the skin is clear. Entering summer with well-moisturised skin and no dry patches will help to prevent eczema flares. If you always use emollients for washing and pat dry thoroughly, repeated washing is no problem. – Julie Van Onselen
Dr Martin Ward Platt, a consultant paediatrician who was not involved in the study, said that bath emollients should still be available for “people who want to give them a try or use them out of personal preference.”
What baby eczema cream should I use?
Topical steroids for baby eczema
Your doctor may recommend the use of topical steroids to treat your baby's eczema. That might sound daunting, but your doctor will be able to tell you the right strength of cream for your baby and show you how much to apply.
As a general rule, topical steroids should be used for short-term treatment bursts – once a day for seven days and then every other day (but, again, this is a general rule, so make sure you get prescribing advice from your doctor). Eczema should then be controlled and dry skin prevented with emollients for washing and bathing. – Julie Van Onselen
What about over-the-counter moisturisers, emollients, creams or ointments?
You might feel a bit at sea when it comes to deciding what will work best in treating your baby's eczema. Having been there, done that, Mumsnet users have some recommendations on the best eczema cream for babies.
Just bear in mind that what works for other babies might not work for yours – and can even exacerbate things. Annoyingly, it's a bit of a case of trial and error. Always read the ingredients carefully and double check the product with your doctor/dermatologist if you're unsure.
Also, it's worth noting that a lot of Mumsnet users say that they had to change products a few times, even in the case of ones that seemed to work like a charm in the beginning.
It's worth bearing in mind (especially at 1am, elbow deep in emollient) that most babies will eventually grow out of their eczema. It's also useful to remember, again, that your baby's eczema journey is particular to them – and what may work for one child might end up exacerbating things in another. More than likely, it'll be a process of trial and error – so stay strong, keep going, and don't be afraid to venture out to find what works for you.
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