Q: My baby has red patches on his skin. How do I treat it?
A: Baby eczema is common and treatable in infants. It occurs in about 10 percent to 15 percent of children. The patches of eczema are typically red, dry, rough and often itchy. The most common sites involved are the flexural creases of the elbows, knees or the cheeks. Eczema occurs when the barrier function of the skin becomes abnormal. This results in increased loss of moisture and as well as decreased protection from topical irritants. This combination is what causes drying and inflammation of the skin. Heredity is a big factor in whether an infant gets eczema. If mom or dad have eczema, a baby is more likely to develop it, too.
About 40 percent to 50 percent of children outgrow eczema before school age but some kids will have eczema into adulthood. Remissions do happen and can last for years, though the tendency for these patients to have dry skin often lingers. There are a variety of eczema triggers to avoid:
Dry skin. This is often caused by low humidity, especially during winter when homes are well-heated and the air is dry. Dry skin can make a baby's eczema itchier.
Irritants. Think scratchy wool clothes, perfumes, body soaps, and laundry soaps. These can all trigger a baby's eczema flares.
Stress. Children with baby eczema may react to stress by flushing, which leads to itchy, irritated skin — and an increase in eczema symptoms.
Heat and sweat. Both heat and sweat can make the itch of infant eczema worse.
Allergens. There's still debate as to whether food allergies in children trigger eczema. Some experts believe that removing cow's milk, peanuts, eggs, or certain fruits from a child's diet may help control eczema symptoms.
Treat mild eczema with moisturizers containing ceramides, which can be found over-the-counter or by prescription. In general, lotions should be avoided because of the high water and alcohol content. Instead, opt for a good moisturizer, fragrance-free cream (such as Cetaphil or Eucerin), or ointment such as petroleum jelly. When used daily, these will help your baby's skin retain its natural moisture. Applying immediately after a bath improves the moisturization. Regarding bathing, baths should be lukewarm, brief and only a few times per week. If your infant is itching quite a bit, a cool bath may help lessen the itching.
If over-the-counter moisturizers are not completely effective, topical steroids may be necessary. There are over-the-counter topical steroids as well as prescription creams and ointments. These can help lessen the redness and inflammation of a baby's eczema, when used as directed. These medications can lead to thinned skin and other issues if applied for too many days to the same part of the body, so it is important to use them only as directed.
For moderate to severe eczema, your doctor may prescribe two different topical steroids; one for regular use and a more potent one for severe flare ups. There are also other topical treatments are available by prescription to ease inflammation. Your family doctor or pediatrician may use these in place of or in addition to topical steroids.
It is very important to control the itching because scratching can cause more irritation and even result in in skin infections. Once an eczema flare up is controlled, it is very important to keep up with daily application of a moisturizer to prevent recurrence.
By Daniel Sutton, MD, ThedaCare Physicians-Waupaca.