Eczema is a skin condition that causes the skin to be irritated, itchy, scaly, and red. It may affect infants, children, and adults, and may also be more prevalent in some families. Approximately 90% of people with eczema experience it before the age of 5. Eczema often appears during the first 6 months to 5 years of a child’s life.
Eczema can cause increased allergic reactions by affecting the immune system, leading to blisters and the breakdown of the skin's protective barriers against diseases. However, effective prevention and treatment options are available for babies and toddlers.
Types of Eczema in Babies
Eczema in babies is primarily due to irritants, environmental factors, genetics, or allergies. Therefore, it is not contagious and does not spread from one person to another. There are several types of eczema in babies and children.
Atopic dermatitis is the most common form of eczema that typically begins during infancy or early childhood, but it can develop at any age.Children with a family history of atopic dermatitis, asthma, or hay fever are at a higher risk of developing atopic dermatitis.
Seborrheic dermatitis mainly affects areas of the body abundant with sebaceous (oil-producing) glands such as the scalp, nose, and back.Seborrheic dermatitis that manifests on the scalp in infants is more commonly known as "cradle cap." It may occasionally manifest on an infant's face, particularly around the eyes and nose.For older children and adults, the manifestation of seborrheic dermatitis on the scalp is known as dandruff. In contrast to other types of eczema, seborrheic dermatitis is not triggered by allergies.
Dyshidrotic eczema is characterised by the development of small blisters on the palms of the hands, soles of the feet, and the edges of the fingers and toes.This type of eczema seems to be more prevalent in individuals with other forms of eczema and appears to have a genetic predisposition.
Contact dermatitis occurs when the skin becomes irritated or inflamed in response to contact with a substance that triggers an allergic reaction. The rash may produce bumpy itches (hives), and the skin becomes thick and scaly. Irritant contact dermatitis affects the skin immediately as skin cells are damaged due to exposure to irritating substances whereas allergic contact dermatitis is a delayed allergic reaction due to exposure to an allergen.
Causes of Eczema in Babies
The cause of eczema has yet to be fully understood. Still, there is a strong genetic component, and individuals with a family history of eczema are at a higher risk of developing the condition.
Many babies with eczema exhibit a genetic abnormality in the outermost layer of the skin, known as the epidermis. The epidermis acts as the body's initial defence against the environment, preventing the entry of irritants, allergens, and microbes while preserving skin moisture.
This protective barrier is often weaker and more permeable than normal in individuals with eczema. A compromised skin barrier in children with eczema contributes to increased water loss from the skin, resulting in dryness. A weakened skin barrier also allows easier entry for irritants, potential allergens, bacteria, and viruses.
Contrary to common beliefs, eczema in babies is seldom associated with food allergies. If there are concerns about a potential food allergy in a child with eczema, please consult your doctor.
Symptoms of Eczema in Babies
Most individuals with eczema experience their initial symptoms before the age of five. Eczema symptoms are diverse, can vary from person to person, and may evolve over time. While eczema typically affects specific areas of the body, it can affect multiple areas in severe cases.
Common symptoms include intense itching of the skin, areas of inflamed skin, the presence of small bumps, and skin flaking. Scratching can exacerbate skin inflammation and intensify itching, with symptoms often more noticeable at night. Persistent scratching in individuals with eczema can increase the risk of skin infections. Signs of infection may include painful red bumps that could contain pus.
Eczema is a chronic condition characterised by periods of improvement and flare-ups, where symptoms worsen periodically. Flare-ups of atopic dermatitis can exhibit a cyclical pattern, persisting for years with periods of improvement and recurrence. Even as the skin heals in one region, flare-ups may manifest in other areas, and it is not uncommon for flare-ups to recur in the exact location. Over time, it can lead to changes in the skin, resulting in thickening, scaliness, and a leathery texture. The skin may also become cracked due to dryness.
Diagnosis for Eczema in Babies
Diagnosis is based on a comprehensive assessment of your baby’s medical history, symptoms, and physical examination as there are no specific tests to diagnose eczema.
Factors that contribute to a diagnosis of eczema include evidence of long-term and recurrent itching, the onset of symptoms, and a family history of specific allergic conditions (asthma, seasonal allergies, eczema).
A detailed allergy test may be conducted if certain allergies are suspected.
Treatments and Management of Eczema in Babies
While eczema cannot be cured, effective treatment measures can help control and manage the symptoms. Eczema is not contagious and cannot be transmitted from one person to another through direct contact.
Following are some methods to manage eczema in babies.
Bath your baby with lukewarm water instead of hot water, as hot water can potentially strip the skin of its natural oils, leading to increased dryness. Use an unscented, mild soap or a non-soap cleanser sparingly to avoid further irritation. After bathing or showering, apply an emollient immediately to lock in moisture and prevent the skin from drying out due to water evaporation.
Use emollients to moisturiseyour baby’s skin and prevent it from drying out. The most effective emollients for eczema are typically thick creams or ointments that contain minimal water. These products are especially beneficial when applied immediately after bathing. For optimal results, emollients can be applied at least twice a day or more frequently if necessary.
Lotions, which have a higher water content compared to creams and ointments, are generally less effective in moisturising the skin and may be less suitable for individuals with eczema.
As eczema is itchy, it is crucial to ensure that your little one does not scratch it, as it could cause tears in the skin, resulting in infection. Make sure to trim your baby's fingernails to avoid scratching. You could even consider using mittens to prevent accidental scratching while the baby is asleep.
Topical corticosteroids are commonly used to treat eczema, and they help reduce inflammation and itchiness. There are many forms of corticosteroids, including ointments, sprays, lotions, and creams.
Identify and keep a close watch on the trigger elements which cause your baby’s eczema and avoid them. Common triggers for eczema include bodily triggers such as sweat, saliva (particularly in infants, leading to conditions like drool rash), and scratching (can exacerbate symptoms). Environmental triggers include tobacco smoke, dry air, pet dander, and pollen. Product triggers include clothing (especially those made from certain fabrics), laundry detergent, fabric softeners, shampoos, or soaps (especially those containing fragrances), baby powder or wipes.
Prevention of Eczema in Babies
There is no definitive way to prevent eczema. Some useful observations and recommendations for babies with a family history of eczema include using good skin care for babies such as moisturising creams or ointments. While it is not yet established whether this can prevent eczema, it can help maintain skin hydration.
Choosing products in a tube rather than a jar can be a good practice. This helps prevent contamination, as you are not repeatedly dipping your fingers into the product.
Research is still ongoing, and recommendations may evolve as more is learned about eczema and its prevention.
Make an Appointment at Gleneagles Hospitals
Eczema in babies is common and treatable in most cases. Early intervention and proper management can significantly improve symptoms and the child's overall well-being.
Get in touch with us to find out more about our Paediatric Services at your nearest Gleneagles Hospital. A dedicated team of paediatricians is ready to provide medical assistance if your child has eczema and related skin conditions.
