Babies Who Have Eczema

There are different skin disorders, some of which can start very early on in life, such as cradle cap.

Cradle Cap

This thick scurfy scalp can appear soon after birth or when the baby is a few months old.  It can develop suddenly. The scalp becomes coated with greasy yellow scales that stick to the head giving a crusty appearance. This scaliness can affect other parts of the baby’s face and head including the forehead, temples, eyebrows, behind the ears and in the neck folds. The skin underneath the scales may look sore, but it is not a condition that causes discomfort or itching and baby will feed and sleep as normal.

During the first few weeks the condition is usually due to the continuing secretion of the greasy coating seen on babies straight after birth. When this dries up the scalp clears.

If the cradle cap develops later on it may be due to infantile seborrhoeic eczema and is usually seen on other parts of the body such as the groin and under the arms. Psoriasis can also look like cradle cap in infancy as it also causes a scurfy scalp.

If the cradle cap doesn’t seem to be clearing up consult your Doctor. If your baby has accompanying symptoms such as diarrhea, vomiting or fever, or is fretful, listless and not feeding properly, see your Doctor straight away. These symptoms may be an indication of psoriasis or seborrhoeic eczema which need a different form of treatment. Or, of course, they can be symptoms of other illnesses.

Treatment

If your baby is diagnosed as having cradle cap, the first thing to know is that you don’t actually have to treat it. It is not doing the baby any harm and will go away of its own accord.  But if you find it unsightly you can try the following to speed things up:

• Shampoo gently to remove the crust and excess scales. Wash the scalp daily, using a mild baby shampoo and tepid water, but make sure you rub very gently.
• Massage the baby’s scalp using slightly warmed olive oil. Again, make sure you work the oil into the scalp very gently. Leave the oil on for an hour or two and then wash it off with a mild shampoo.

Alternatively, you could massage emulsifying ointment or aqueous cream into the scalp, leave it on for a few hours and wash off with warm water. These creams mix well with water so you don’t need to use shampoo as you do with olive oil.  If the ointment seems too solid, stand the jar in a bowl of warm water to soften it a little. Be careful not to apply too much pressure as you massage, paying extra attention to the fontanels (the soft part at the centre of the baby’s head). Do this daily until the scalp clears.

Infantile Seborrhoeic Eczema

This condition can appear quite suddenly between two weeks to six months after birth. You may notice it first on the nappy area, but it seems to quickly gather momentum and you may find that it has quickly spread and is on the scalp, face (often including the forehead, temples, eyebrows and behind the ears), neck, armpits, nappy area and trunk. The good news is that it improves almost as quickly as it spreads! Also, it looks worse than it is. It is not a very itchy condition, nor is it sore. The baby feels well and will eat, sleep and play normally.

Seborrhoeic eczema on the scalp appears in the form of large, yellow, greasy scales which stick to the scalp making it look crusted. This is why it is often mistaken for cradle cap.

What causes the condition is unknown. Family history of skin conditions does not seem to play a part; nor does it mean that it is going to turn into atopic eczema or another skin condition. The baby may go on to get atopic eczema but it is not related. One in ten children under the age of five have atopic eczema: some of these will have had seborrhoeic eczema as well.

A certain type of yeast has been found on infants who have seborrhoeic eczema and this may be the cause of the rash. But please note that this is not caused by yeasts in the baby’s diet.

In its mild form, seborrhoeic eczema is unlikely to become infected. As long as the skin is unbroken it should not cause any problems and is easy to treat. You would be right in suspecting a bacterial infection if the baby’s skin feels hot, smells odd, or is weepy. This is most likely to occur in the folds of skin.  You need to see your doctor if this happens. Also the skin may become raw and sore, particularly in the nappy area, and become infected by a yeast called candida which lives on the skin in that part of the body. This can lead to thrush. There are creams available to treat severe cases of this condition.

Treatment

• Bathe the baby daily but don’t use soap or bubble bath as both these dry the skin. You can use a soap substitute like aqueous cream, or emulsifying ointment which you can obtain from the chemist. Gently rub the cream or ointment on to the damp skin and then wash it off in the bath. You can also get special bath oils to help moisturize the skin.  Please be extra careful as the baby will be very slippery.
• Moisturize the baby’s skin all over with an aqueous or moisturising cream. Do this several times a day to keep the skin soft and supple. If the skin is sore in places, your Doctor may prescribe a weak steroid cream – with 1% (or less) hydrocortisone. Use this sparingly and only in the areas where the skin is sore. If the skin is infected the Doctor may prescribe a cream that contains an antibiotic as well as a mild steroid. In the case of thrush the special cream prescribed may be a formula containing an anti-yeast with the steroid. All these creams should only be applied, in small quantities, to the areas infected.
• If it is crusty or scaly, treat the scalp in the same way as cradle cap described above. Again, if the scalp is very sore, your Doctor may prescribe a mild steroid cream to use sparingly until the condition improves.
• Change nappies frequently and keep the nappy area clean and dry. This should prevent the skin becoming sore and infected. You may need to change the nappy every hour certainly change them as soon as they become wet or soiled.  If the nappy is wet or soiled, wash the area in a little warm water with oil or cream added.  At every nappy change apply an aqueous cream or zinc and castor oil cream to keep the skin soft and protected. Try not to use plastic pants over nappies as they can create hot and humid conditions which help the bacteria breed and can make the eczema worse.

These treatments are time consuming and can be very tiring, but if the baby’s skin is sore and infected this extra attention is necessary to help the healing process.

Atopic Eczema

This condition can develop at any time. It is far more distressing than cradle cap or seborrhoeic eczema because it is itchy and sore. It can appear anywhere on the body, often starting on the face when the baby is three or four months old. The cheeks can become very red and sore, and it then migrates to other parts of the body. The eczema is usually particularly apparent in the body folds; in the backs of the knees and creases of the elbows, on the wrists, ankles, neck, ears and nappy area. It also appears on the eyelids and scalp. One early tell-tale spot is in the place where the ear lobes join the face. If this spot looks at all sensitive, suspect eczema and be careful when you dress and undress the baby. It is very easy to split that part of the skin when you are removing clothing.

Atopic eczema is a dry, scaly, inflamed skin condition. When it is hot the skin dries and cracks open. It is important not to let the baby get too hot or cold. Make sure the bath water is tepid.  A baby with eczema does not have the same temperature control as babies without this condition.

The severity of the eczema can be very different from baby to baby. One will just have a mild rash say, on the elbows and knees with sensitive or cracking earlobes while another will be covered with an itchy, red, sore, and weepy skin and obviously in constant discomfort.

How do you tell if your baby has eczema? Here are some guidelines but please note that the following is just an indication and you really do need to get a diagnosis from your Doctor:

Indications of Atopic Eczema in Babies

• Itchiness is a strong factor but babies tend to rub more than scratch.  Look out for redness in the forehead and the wrists as well as cracking and breaking of the skin.
• A dry skin is very indicative of atopic eczema.
• If the eczema is infected it will be weeping and oozing and there may be yellow/brown crusting.

Treatment

You cannot stop a baby rubbing or scratching and you should never make any attempt to tie a baby’s hands or restrict movements as this would add to the baby’s stress and could make the eczema worse.  But you can lessen the effects of the rubbing or scratching by:

• Keeping the baby’s nails short
• Covering the baby’s hands with cotton mitts. Alternatively, you can put cotton socks over the hands having taped the socks to a long sleeved garment the baby is wearing.
• Using cot bumpers can ease the effects of rubbing.

Minimizing the itch factor is always a question of keeping the skin moisturized and as free as possible from secondary infection by means of special baths.

Bathing Babies

Bath babies daily in a bath of tepid water to which a special oil or emollient has been added. Emollients are ointments or creams which are mixtures of water, waxes, fats and oils in varying proportions and they can come as ointments which are better on a very dry skin, so you may want to use that at night, with cream for the daytime. Emulsifying ointments and creams are not as easy to disperse throughout the bath as oil, but you can add a tablespoonful of emulsifying ointment to boiling water and mix these together first, in a separate container, before adding them to the bath.

If the baby is fretful during bath times, add lots of toys to the bath as playing with them will help extend the bath and hence the treatment time. But remember never to leave a baby unattended in the bath, and don’t forget that he/she will be very slippery when you take him/her out.

• Never use soap or bubble bath which dries the skin.

Emollients are safe to use and rarely cause allergic reactions, but products containing lanolin, which is a fat derived from sheep’s wool, can occasionally have this effect.  It really is a question of trial and error to find out which products suit your baby best.

Moisturising

Moisturising the skin is very important as it keeps it supple and less likely to crack. You will need to do this at least twice a day, using emollient cream. After the bath is a good time as the skin is moist. Pat the skin with a soft towel leaving it slightly damp. First apply any steroid creams or ointments you have been prescribed, allow time for the medication to be absorbed and then gently apply the emollients.

Always wash your hands before applying creams or ointments and make sure that containers are closed tightly straight after use. Eczematous skin can become infected if the contents of the container are contaminated. If you have more than one eczemous person in the family make sure each has his or her own supply of emollients to avoid cross-infection.

Apply cream thinly and smooth it in. If the preparation is thick, apply it in small dots on the parts of the body affected, working from the head to the toes, so the cream will have melted and become more manageable by the time you come to gently smooth it in.

In addition to knowing the names and purposes of the different creams you will be using, it is useful to record how much cream you are using. It usually comes in the following weights: 15 gm, 30 gm, 50 gm or 100 gm. Note how many tubes or tubs you use and compare it with the guide below.

Minimum amount of emollient cream (gms) required for twice-daily application for one week.

Treating With Topical Steroids

The word ‘topical’ means something that you apply at the site of the problem. Steroids are substances produced by the body to help the healing process. Steroids produced for medicinal purposes aim to have the same effect.  They can be very helpful in treating all manner of illnesses, but taken orally (by mouth) they can have serious side effects, one of which is to restrict growth. This is very unlikely to happen with steroid formulations applied to the skin, but having said that, bear in mind that a baby’s skin is very permeable. This is why steroid creams and ointments prescribed for babies are usually of a very weak formulation (1% hydrocortisone) unless there is a special reason for the extra strength – in which case the treatment is likely to be only for a short time.  Also, strong doses of steroids used over a long length of time can produce thinning, stretch marks and reddening of the skin.

However, topical steroids can reduce itchiness and speed up healing so they are extremely useful in controlling a flare-up of the condition. Used with caution, they can often spare both the baby and parents undue suffering.

If the eczema becomes infected you must see your Doctor straight away. Infected eczema can be tricky to treat on anybody, but a baby obviously has to be very closely monitored.

It is not the policy of the Eczema Association of Australasia Inc to recommend or endorse any product or treatment.
It is part of the role of the Association to provide information on a wide range of products and treatments to keep those involved with eczema as fully informed as possible as to all options available. For medical advice, consult your health professional.