Baby Eczema Causes and Treatment: A Parent's Guide
A few years ago, when Alexandra Torres Fung's infant son started showing signs of eczema, she thought she had it under control. After all, the Nicaraguan American mom's older kids have the skin condition (as do nearly 10 million kids in the U.S.), and so does she. Torres Fung, the cofounder of the parent-to-parent recommendations site Upparent.com, knew to use gentle detergents and moisturizers, and to avoid dabbing colonia para bebés on his skin (to her mom's and Abuela's disappointment). She put tiny mittens on his hands at night to curb his scratching. But the red and pink patches on his cheeks, which arrived when he was a few months old, only worsened.
Then other sensitivities began to appear. Eating dairy exacerbated his rash and made him fussy. He had a reaction to eggs at 10 months, then another to peanuts at 1 year. She took her son to an allergist, who diagnosed the boy with several food allergies, some mild, others severe, and made an unexpected correlation: "That's when I first learned that eczema is closely related to those allergies."
Research has shown that kids with eczema are vulnerable to a phenomenon called the atopic march, in which eczema's trademark itchy, inflamed skin helps bring about any or all of the following conditions: food allergies, asthma, and hay fever (also known as allergic rhinitis). According to data from the Centers for Disease Control and Prevention (CDC), about 17 percent of Black children and 10 percent of Latinx children in the U.S. have eczema and tend to experience more severe cases than white kids. The reasons for this aren't clear, but genetics, lack of access to specialists, and environmental conditions such as exposure in urban settings to dust, mold, and other allergens may play a role, says Neeta Ogden, M.D., an allergist-immunologist and spokesperson for the American College of Allergy, Asthma, & Immunology.
That all sounds alarming, of course. But even if your child is already acquainted with the skin ailment, there's no need to panic. New insights about preventive care, early intervention, and diligent maintenance are revealing that eczema may be more treatable, and the allergic progression less inevitable, than previously thought. By equipping yourself to know the signs, you can be your child's own best advocate.
What Does Baby Eczema Look Like?
Eczema is a chronic condition that usually appears on the face, scalp, or trunk, arriving anywhere from several weeks to several months after birth. It typically creeps to the elbows and knees when a child is around 6 months old, though it can affect any part of the body. The thing is, every baby is a little bundle of highly sensitive skin, which makes it difficult to know whether you're dealing with eczema or just garden-variety irritation. But there are clues to look for.
"If you, your partner, or your other children have ever suffered from eczema or allergies, it's especially important to bring any skin issues to your pediatrician's attention," says Sandy Skotnicki, M.D., assistant professor of dermatology at the University of Toronto and author of Beyond Soap.
Diagnosing Baby Eczema Symptoms
Even if you're fairly confident that your child has eczema, you may need to be persistent with your pediatrician to get a diagnosis. And know that the typical signs of eczema (such as red patches) show up differently in darker skin tones, says Ana M. Duarte, M.D., director of dermatology at Nicklaus Children's Hospital and founder of the Children's Skin Center, in Miami. Patches can appear darker brown, purple, or ashen in color, which doctors may miss, as Ayren Jackson-Cannady, a Black mom in Arlington, Virginia, can attest to. Her oldest child, Trey, 10, suffers from eczema. She knew what the condition looked like because her husband is also a lifelong sufferer. Yet that information, coupled with Trey's itchy rash, didn't ring any warning bells for his doctor, even though Jackson-Cannady brought it up at every pediatrician's visit. She believes his skin color played a part in that.
"My husband and I were shocked by how many doctors were so cavalier about it, saying things like, 'He'll grow out of it' or 'It's not red or inflamed, so it's probably just dry skin,' " she says. They didn't seem to consider that Trey's brown skin might affect the appearance of eczema. "He literally had to get an infection from scratching his skin open for one doctor to realize that a bottle of lotion wasn't going to cut it," says Jackson-Cannady. Finally, she and her husband found a dermatologist for Trey on their own, and he was officially diagnosed with eczema at age 3.
Unfortunately, misunderstandings about the condition—and who is at greater risk—appear to be widespread among physicians. Many parents report that their child had to see multiple doctors before their eczema was diagnosed and treated. That delay can have long-lasting negative consequences. "Early diagnosis and intervention might help prevent certain aspects of the atopic march, and it certainly can ease severity," Dr. Ogden says.
Another reason to tackle eczema earlier: "There's an increased risk of infection the more the itch-scratch cycle accelerates," Dr. Duarte says. And in people of color, scratching or the inflammation from eczema itself can lead to hypopigmentation (lighter patches of skin) or hyperpigmentation (darker patches of skin). "These changes can last for months or years but in general resolve over time in patients who achieve good control over their eczema."
How Eczema is Connected to Food Allergies, Asthma, and Hay Fever
The process by which eczema can lead to the other steps in the atopic march can be hard for people to understand, says Dr. Skotnicki. Picture eczema, food allergies, asthma, and hay fever as dominoes. Each can fall on its own, but they are all more likely to be knocked over if the first domino—eczema—falls. According to a review of studies in the Journal of Allergy and Clinical Immunology, 81 percent of kids with eczema go on to develop at least one food allergy. If this occurs, they are then seven times more likely to be diagnosed with asthma and nearly 12 times more likely to develop seasonal allergies.
- RELATED: All About Food Allergies in Babies
Why is this so? "Essentially, atopic eczema is a skin-barrier disruption, leaky skin, if you will," Dr. Skotnicki explains. The skin is supposed to keep water in and irritants and allergens out. But eczema-affected skin fails to provide such a barrier, and its susceptibility to dryness and irritation can cause tiny tears that allow miniscule amounts of allergens to enter the body. Think peanut dust on a bakery table that hasn't been wiped down thoroughly enough, on which your little one puts their forearm. Think pollen floating through the air (and into your child's sinuses) or chemicals in your laundry detergent, which touch your baby's face when they rest their cheek on your shoulder.
When these invaders make contact with skin affected by eczema, "the immune system freaks out and mounts a response," says Peter Lio, M.D., clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine, in Chicago. That response can lead to an allergy to those foods or irritants—one that can last for the rest of the child's life.
Preventing Baby Eczema
The good news is that parents of little ones at high risk for eczema (meaning their parents or siblings have the condition or have food allergies) are not powerless. Step one: Limit baths. "The first thing we need to do is stop washing children so much and for so long," says Dr. Skotnicki. "Water and soap actually break down the skin barrier we want to strengthen." According to the American Academy of Pediatrics, three short baths a week during a baby's first year are probably plenty. They should last only five to ten minutes, and you should use a mild cleanser without additives. Dr. Skotnicki adds that no small child requires more than that unless they're truly dirty or sweaty, or they've already been diagnosed with eczema. In the latter case, bathe your child daily during flare-ups, but for no more than ten to 15 minutes in lukewarm water, with no soap. "Patting, not rubbing, your child dry and moisturizing within three minutes after the bath is also key," Dr. Skotnicki says.
Another counterintuitive—but clinically proven—strategy for halting the atopic march: early exposure to peanuts. When children between 4 and 6 months old who are at high risk for eczema start consuming peanut products, their chance of developing peanut allergies plummets by 74 percent, a major study concluded. Of course, this should happen with a pediatrician's okay; for babies who already have severe eczema or a family history of the condition, nuts need to be introduced only under an allergist's guidance. "You want a child's first exposure to common allergic foods to occur via the gastrointestinal tract, not the skin," Dr. Lio says. "When a baby ingests a food, the gut has special systems designed to induce tolerance so they won't become allergic. That doesn't happen with skin exposure." In short: The goal is to get common allergic foods into your baby's belly before they can wreak allergic havoc by being absorbed through the skin.
"Some studies have also shown that moisturizing high-risk infants daily with rich, oily emollients such as Vaseline or sunflower-seed oil can reduce the risk of eczema by up to 50 percent," says Dr. Lio. Emollients can create a physical barrier when the skin can't provide its own, he explains. There have been conflicting studies about this practice—it's an emerging avenue of research—but Dr. Lio still encourages families with high-risk babies to follow it daily from birth through 6 months in order to prevent or delay eczema. That said, be careful what product you try. Run any natural oils, herbs, and salves—plus home remedies passed down from Abuelita— by your child's health-care provider.
How to Treat Baby Eczema
Parents of kids with eczema have traditionally been given the same advice because it works: Moisturize often, limit exposure to triggers (irritants such as secondhand smoke and scented detergents), and use topical corticosteroids (hydrocortisone creams) to stop the itching that comes with the rash. Dr. Skotnicki notes that "daily moisturizing and proper cleansing are the cornerstones of eczema therapy, and they do result in better outcomes." However, some parents may be reluctant to use corticosteroids on their children because of possible side effects, such as thinning skin. Even if parents feel comfortable using the creams, doctors advise using them only during severe flare-ups and for seven days at a time.
That's why Dupixent, a steroid-free injectable approved for kids ages 6 and up with moderate to severe eczema, has been called a game changer by parents and doctors. After 16 weeks of monthly treatments in combination with a topical corticosteroid, more than 75 percent of kids ages 6 to 11 with severe eczema showed a 75 percent skin improvement. Dupixent is available by prescription only, and it does require a child to get an injection every other week. However, for many families, it's well worth it.
For babies and kids with mild to moderate eczema, there's also Eucrisa, a steroid-free prescription ointment that reduces symptoms by blocking the production of pro-inflammatory proteins called cytokines.
Torres Fung uses a combination of OTC moisturizers and EpiCeram, a prescription nonsteroidal topical barrier enhancer, to keep her son's eczema flares at bay. Now 4 years old, he doesn't have problems with his skin on most days. And all the things that Torres Fung learned dealing with his eczema helped her handle it better with her fourth child, 2, who started showing signs of the skin condition at about 9 months. Luckily, this time around, Torres Fung and her husband knew exactly what to do. "We made an appointment to see the allergist, both to evaluate the eczema and to do allergy testing," Torres Fung says. "And, thankfully, his eczema never got quite as bad as his brother's, and it also went away sooner."
She did exactly what Dr. Ogden recommends all parents do: "Catch eczema early, stay on top of it, learn all that you can about early peanut introduction, and, above all, don't hesitate to be proactive."
Best Moisturizer for Eczema
Using a dye- and fragrance-free emollient is key to controlling eczema. The problem? Eighty-three percent of the best-selling moisturizers featuring a "hypoallergenic" label include at least one potentially allergenic chemical, and 45 percent that claim to be fragrance-free are not, a 2017 study in JAMA Dermatology found. Your best bet is to choose "greasy" ointments and creams (high oil content more effectively keeps moisture in and irritants out) that feature the National Eczema Association Seal of Acceptance, such as CeraVe Baby Healing Ointment and Aveeno Baby Eczema Therapy Moisturizing Cream. You can also search for products on the association's website.
Is Eczema a Gateway Rash?
Not every kid with eczema hits each stop on the atopic march. There are children who never develop any of the other related conditions, says Dr. Neeta Ogden. Although not all journeys progress in this order, here are some of the diagnoses that can follow eczema.
Food allergies: Research has shown that Black and Latinx children have higher rates of food allergies compared with white kids. Common ones associated with eczema are egg, peanut, soy, and dairy, with symptoms including hives, itching, swelling of lips, face, tongue, or throat, and nausea or vomiting.
Asthma: According to data from the CDC, compared with white children, Black kids are 2.6 times more likely to have asthma, and Latinx kids are 1.4 times more likely. There are many reasons for the disparities, including genetics, environmental pollution (such as exposure to secondhand tobacco smoke), limited access to good health care, and distrust in medical establishments. Kids with asthma may experience any number of symptoms, including a cough that is worse at night or triggered by exercise, cold air, viral colds, or flu; and wheezing, congestion, trouble breathing, shortness of breath, or a tight or uncomfortable feeling in the chest. Asthma might not be diagnosed until a pattern of chronic breathing issues is observed.
Allergic rhinitis: With these seasonal allergies, children are often congested; experience repetitive sneezing and a sore throat; feel itchy in their mouth, nose, ears, or eyes; and have trouble with snoring. Eczema can also bring about allergies to pet dander, mold, and dust, all of which have the same symptoms as allergic rhinitis.
This article originally appeared in Parents Latina's October/November, 2021 issue as "What to Do About Eczema."