What is eczema?

Eczema is a dry, itchy skin condition that affects up to one in five children. It usually appears for the first time before your child is two years old. The good news is that most children who have eczema will grow out of the condition by the time they are in their teens. Eczema can’t be cured, but it can be controlled with the right treatments.

Eczema is also known as atopic eczema, or atopic dermatitis. Atopic means that your child has inherited the tendency to develop conditions such as eczema, asthma and hayfever. The end result is the same: dry, itchy, red and cracked skin, which can sometimes ooze fluid and bleed. The areas most affected in babies are the hands, face, neck, elbows and backs of the knees.

Having eczema means that the skin’s barrier doesn’t work as well as it should, which makes it drier. His skin will be more prone to infections and allergens can enter the skin more easily, which can make the condition worse.

What causes eczema?

We don’t know exactly what causes eczema, but genes may play a role. Allergic conditions, including eczema, asthma, and hayfever, have increased over the last few decades, though it has started to level off.

Eczema affects the skin in flare-ups. Your baby’s skin may have dry and itchy patches of skin most of the time, but during flare-ups, these areas worsen and become inflamed. This happens as his immune systems overreacts to substances he’s allergic to (allergens). He may then need more intensive treatment.

Eczema flare-ups can sometimes be triggered by skin irritation caused by chemicals, such as the detergents in bubble baths, shampoos, washing powders and fabric softeners. Use bath emollient rather than soaps and detergents in the bath. You could also try changing your washing detergent to non-biological, to see if this improves your baby’s eczema.

Eczema can be extremely distressing in babies because they find it very difficult not to scratch, which can lead to infections. In some cases eczema can disturb your child’s sleep and affect his confidence.

How can I treat my baby’s eczema?

The treatment of eczema depends on its severity. If your child has mild eczema with only a few red and itchy areas, you may simply be advised to use an emollient lotion, cream or ointment, sometimes combined with a short course of a low-strength steroid cream.

Moisturising your baby’s skin to prevent flare-ups is crucial. All children with eczema need to use liberal quantities of an emollient several times a day, even if no patches of eczema are present. This prevents skin from drying out too much.

There are a huge variety of moisturisers or emollients available and you may have to try several to find the one that suits your child best. These are available as creams, ointments, lotions and bath additives.

You may have to use large quantities of emollient on a regular basis. Your doctor should regularly offer repeat prescriptions once you know which one works best. Aqueous cream is an emollient that is best avoided. It can contain detergents that can irritate your child’s skin.

Will using steroids harm my baby?

Doctors often recommend that eczema in babies is treated with steroid cream or ointment, as well as an emollient, from time to time. Steroid creams and ointments are safe if used correctly. Their main side-effect is thinning of the skin if they are used for long periods of time, but there is no evidence that this is permanent.

It’s important to use the correct strength of steroid cream, depending on the severity of the eczema. Steroids should always be used under the supervision of your doctor, who will show you how much to put on your baby’s skin.

When using steroid cream, only use it on the affected areas, no more than twice a day, and remember always to use plenty of emollient cream. You can apply as much emollient as your baby needs.

What other treatments are available?

Oral antihistamines are sometimes prescribed if a baby’s eczema is very itchy and it’s disturbing his sleep, but they aren’t used routinely to treat eczema. The ones normally available for young children often cause drowsiness, so are best used at night. You should seek your doctor’s advice before giving young children antihistamines.

If your baby has more severe eczema, he may need stronger steroid creams or ointments from time to time. If his eczema isn’t responding to treatment, he may need to be referred to a specialist dermatologist for other treatments.

Other treatments that may help severe cases of eczema include dry bandages and wet wrapping, where bandages are soaked in emollient or steroid cream and then dry bandages are wrapped on top. This helps the treatments to soak into the skin.

What happens if the eczema becomes infected?

Eczema can be complicated by skin infections that are often caused by scratching until the skin is broken. If your baby’s eczema becomes infected, it may bleed, crust over or weep fluid, and will need antibiotics to clear up the infection. If only a small area is infected, your baby will probably be prescribed an antibiotic cream. If a large area is infected he will need to take antibiotic medicine by mouth.

Can I do anything to prevent my child’s eczema flare-ups?

• Breastfeeding exclusively for at least four months may help to protect against eczema and other allergies. The Department of Health recommends exclusive breastfeeding for six months.
• Some children who develop eczema may be allergic to cow’s milk, but it’s important to talk to your doctor before removing cow’s milk (or cow’s milk formula) from your baby’s diet. If your baby is formula-fed, your doctor may recommend a trial of a hydrolysed protein formula. Soya-based formulas and goats’ milk formula are not recommended.
• There isn’t any firm evidence that avoiding certain foods while you are breastfeeding or during pregnancy will prevent your child from getting eczema, but it is worth talking to your doctor if you are breastfeeding and eating a certain food seems to cause a reaction in your child. Don’t alter your diet unless you have discussed it with your doctor first.
• There is some evidence that taking probiotics (either in the form of a supplement or food such as yoghurt) during pregnancy may reduce the chance of your child developing eczema, but more research is needed.