What is baby eczema?

Doctors do not know exactly what causes atopic dermatitis. However, many think a combination of genetics and environmental factors is responsible.

Newer research into the causes of AD indicates that it tends to occur with skin barrier problems, exposure to environmental irritants, and skin microbiota. The skin’s bacterial composition is different in people with AD due to the increased adhesion of various bacteria to the skin of those who have the condition.

Researchers think genetic mutations relating to the immune system and the function of the skin barrier contribute to the likelihood of developing eczema. Other factors that contribute to AD development include environmental factors and where a person grows up.

Additionally, researchers are investigating the role of the skin’s microbiome and how different bacteria, viruses, and yeasts protect against or contribute to eczema symptoms.

Eczema in infants tends to start as dry, scaly, itchy skin, mainly on the cheeks and scalp. It can also appear red, scaly, and oozy. Itching tends to come and go. Older children often develop itchy, red, scaly rashes in the skin folds, such as the creases of the knees and elbows. Eczema also can appear on the neck, wrists, ankles, legs, and the crease of the buttocks.

Cheeks

When a baby has eczema on the face, they will likely first develop an itchy rash on their cheeks. The rash usually has a dry and scaly appearance and can blister and break open, leaving a crusty layer. The baby may also act fussy or find it difficult to settle or sleep due to chronic itchiness.

Chin

An eczema rash can spread to other areas of the face, including the chin. Eczema rashes are usually very itchy, so if a baby is not scratching their chin, the rash could be due to excessive drooling while teething. An eczema rash will eventually break open and leak fluid that dries and crusts over.

Forehead and scalp

When a baby has eczema on their forehead or scalp, a caregiver may initially notice a change in their behavior. For example, the baby may try rubbing their head against carpeting or other objects in the home to soothe the itching. An eczema rash will present with dry, itchy scales that may blister and release fluid. As the fluid dries, it leaves a crust.

Atopic dermatitis presents with dry and scaly rashes that are itchy and weep fluid. However, there are other skin diseases that mimic or look like atopic dermatitis. These include:

Seborrheic dermatitis

Seborrheic dermatitis typically presents on the scalp and face but can also occur in the creases of the arm and within the folds of the abdomen. When the condition develops on a baby’s scalp, doctors call it cradle cap.

In contrast to atopic dermatitis, seborrheic dermatitis presents with:

• Patches of scaly skin: These are lighter than the surrounding skin in patients with darker skin color.
• Thick greasy scales: These scales are shinier than the dry scales doctors observe with atopic dermatitis.
• A lack of itching: The itching sensation is much milder than atopic dermatitis and does not disrupt a baby’s sleep.

It is important to keep in mind that a baby can have seborrheic dermatitis and atopic dermatitis at the same time.

Psoriasis

In infants, symptoms of psoriasis are very similar to those of atopic dermatosis. Like atopic dermatitis, psoriasis tends to develop on the face, and the rash presents with dry scales. However, psoriasis is rare in infants and more likely to develop in later childhood.

Unlike atopic dermatitis, the rash often appears in the diaper area. Another distinguishing symptom of psoriasis is nail pitting. Nail pits are small depressions or dents in the finger or toenails. This symptom is extremely rare in infants.

Learn more about psoriasis here.

Ringworm and tinea

Ringworm is a type of fungal infection. The main symptom is a rash with a red border, which can appear suddenly or take a few days to develop. Infants and small children typically develop a ringworm infection on the scalp or forehead. Ringworm is similar to atopic dermatitis in that the rash has a scaly appearance and is often itchy. However, unlike atopic dermatitis, infants may experience small patches of hair loss or alopecia.

Tinea can occur anywhere on the body and presents as a round, red, scaly patch with defined edges that is very itchy. It can have a raised, scaly border and be lighter in the center. The patches tend to be red or pink on lighter skin and brown or gray on darker skin.

Learn more about ringworm and tinea here.

When a baby has acne, white pimples or spots will form clusters on their skin. When they have eczema, the rash is often weepy but will never present with pimples. Acne is similar to eczema in that it tends to develop on the cheeks.

Treatment for eczema in babies has two goals: The first is to alleviate symptoms, and the second is to prevent them from recurring.

Relieving eczema symptoms

To alleviate eczema symptoms, a dermatologist will likely recommend a topical corticosteroid, which reduces inflammation and itching. Topical corticosteroids come in many forms, including creams, lotions, ointments, and sprays.

Caregivers should apply a topical corticosteroid after bathing their baby but before applying moisturizer. It is important they follow their dermatologist’s instructions for application, as babies are more sensitive to these medications than adults.

The most important thing is moisturizing and hydrating the skin. Caregivers should use daily skin moisturizing lotions that are fragrance-free and limited in preservatives. For medications and moisturizers, an ointment may be better than a cream due to the high proportion of oil to water in ointments.

Preventing eczema symptoms

Identifying any potential irritants and triggers that aggravate the skin is one of the most effective methods of preventing a flare-up.

For example, a caregiver may notice a rash developing on their baby’s skin after using fragranced shampoos or soaps. However, not all triggers are environmental. Sometimes a baby may develop an eczema rash in areas where they sweat a lot.

Other common flare-up triggers include:

• dry air
• pet hair (dander)
• pollen
• some washing detergents
• baby powder

Caregivers should also avoid anything scented and use products that say hypoallergenic and fragrance-free. Some preservatives can also aggravate the skin, along with certain fabrics. Cotton is the best.

Since the skin barrier is deficient, moisturizing is the most important thing to do. Around 50% of infants with AD often have or develop food allergies. The most common allergens are milk, peanuts, eggs, soy, wheat, tree nuts, fish, and shellfish.

Bathing technique is also important in reducing the frequency of flare-ups. Caregivers should gently cleanse the skin and avoid scrubbing. They should also keep bath times between 5–10 minutes.

Limiting baths to a few times per week is also a good idea since each bath will make the skin drier.

Caregivers should also ensure that a baby’s nails remain short so they cannot scratch at night, which also worsens symptoms.

A person should contact a doctor as soon as they notice a rash. It is important a doctor treats eczema early, as this will reduce the likelihood of complications, such as infection. If a baby’s symptoms worsen, the rash may take longer to heal.

Eczema, or atopic dermatitis, is a common skin condition in babies. Although a baby may outgrow eczema, symptoms can persist into adulthood. Researchers do not understand why some people develop eczema, though they think a person’s genetic profile and environmental triggers both play a role.

Doctors treat eczema in babies with corticosteroid medications, including creams, lotions, and emollients. To prevent flare-ups from recurring, a person should note any potential triggers that aggravate their baby’s skin.

Eczema symptoms overlap with those of other conditions, such as asthma, food allergies, and allergic rhinitis. Consequently, it is important a caregiver seeks medical attention as soon as possible, so their baby receives the appropriate treatment.