Camber Hess is a Family Nurse Practitioner working at a family practice in Utah seeing all ages and treating a wide variety of conditions. She has 2 kids of her own, ages 3 and 4 months.
Seeing a rash on your little ones can be stressful for any parent, especially when it makes them miserable or interferes with sleep (kids’ sleep OR yours!). Eczema (atopic dermatitis) is particularly common in babies, affecting up to 20% of them, and it can often persist into childhood and even adulthood. Eczema is not curable, but don’t panic, it IS treatable, and it often disappears or at least improves with age. Babies are the most likely age group to have eczema.
How do I know if it’s Eczema?
Eczema is a rough, scaly rash that can appear anywhere on the body, but the most likely places in babies are on the cheeks and chin, and on the trunk, scalp, and outer arms and legs. In older kids it often appears in the creases of elbows, knees, and wrists. It can be reddened, light pink, or flesh-colored and occurs in patches. It is VERY itchy and can interfere with sleep and lead to sad, fussy babies.
What do I DO about it?
The first treatment for eczema is always to moisturize, moisturize, moisturize. This involves applying a good quality lotion at least twice a day, and avoiding anything that would dry the skin out.
Good lotions are thick and free—that is, free of dye or perfumes. Standard baby lotion has both, so throw it out! Rather look for good-quality lotions that come in a tub instead of a pump (pumps often have extra water added to make the lotion thinner). I often recommend Cerave, Aquaphor, or Cetaphil.
The number one culprit for drying skin out is bathing, so minimize baths to 2-3 a week, especially for babies (they don’t sweat, so they really don’t need baths every day! For small kids, often only the diaper area and hair need actual washing.
The second recommendation is to avoid irritants. Avoid harsh soaps or soaps that have added dyes or perfumes—again, baby soap can be a culprit! Instead, look for mild, moisturizing soaps like Cerave ultra hydrating cleanser, Exederm baby bath, Neutrogena ultra gentle, and Aveeno baby cleansing therapy. More information on soaps and eczema can be found at https://nationaleczema.org/eczema-products/cleansers/
Your laundry detergent is probably the easiest trigger to fix for eczema. Most detergent brands have a “Free and Clear” or similar option that is free of harsh dyes or perfumes. Also avoid fabric softener liquid or sheets.
Avoid contact with household cleaners, hand soaps, and disinfectants.
Other triggers for eczema include environmental or food allergies and stress. Common allergens include pet dander (think dogs and cats), house mites, pollen, peanuts, tree nuts, milk, shellfish, eggs, wheat, and soy. Talk to your doctor if you suspect allergies.
Itching and Redness
Eczema can be as miserable as it looks! Sometimes we call it the “itch that rashes”. Moisturizing and avoiding irritants can help minimize itching and redness, but sometimes these poor kids need more.
–Hydrocortisone 1% is available over the counter (sometimes labeled ‘anti-itch cream’) and can safely be applied to problem areas for up to 2 weeks. Since this is a milder steroid cream, it can be applied sparingly to the face, but avoid the skin near the eyes and use it for short-term use only.
–Allergy medication can also be given for itching. You can start with children’s Zyrtec or Claritin (Zyrtec can be given to kids under 2; Claritin generally cannot) for something non-drowsy. Benadryl (diphenhydramine) is stronger but can cause significant drowsiness for some kids. It can also be given to babies—check with your doctor for dosing.
When to see your doctor
Any rash accompanied by fever or respiratory symptoms should be checked out by your doctor, as well as any rash that appears infected (oozing, pussy, bright red, or with yellow crusts).
If the eczema does not respond well to the at-home treatments listed, going to your doctor is a great next step. Not only can the doctor verify that the rash is actually eczema (as opposed to something else), but they can also suggest some other treatments, including prescription-strength steroid creams and other types of medication for eczema.
There are, of course, good resources online to learn more about eczema, in addition to talking it over with your doctor or pediatrician. These are two of my favorites:
The National Eczema Association: https://nationaleczema.org/
The Mayo Clinic guide to eczema: http://www.mayoclinic.org/diseases-conditions/ (search for ‘eczema’ or ‘atopic dermatitis’)