Infant Eczema - Possible Causes & Treatments

Eczema is a common skin condition that affects many people around the world, including babies. According to the National Eczema Association, baby eczema affects about 9.6 million children in the US.

Dealing with eczema can be a real challenge for parents, especially because it can cause children to get irritated and uncomfortable which can result in an upset baby. This can be extremely difficult and nerve-wracking as a parent.

Unfortunately, there is no cure for eczema, but luckily there are ways for parents to manage the condition including several treatments available to relieve or reduce symptoms.

What is Eczema?

Eczema is a skin condition that is characterized by dry skin, itchiness, and red rash on the skin. Eczema is hereditary, and therefore it is caused by genetic factors and exacerbated by environmental factors. For babies, many factors, including climate, allergens, and irritants, can cause eczema flare-ups. Eczema is not contagious, meaning that it cannot be transmitted from one person to another through skin contact.

What Causes Eczema in Babies?

Eczema is caused by the inheritance of specific predisposing genes. Eczema tends to run in families with a predisposition to other atopic diseases like asthma, food allergies, and hay fever. 

Children with eczema are likely to have filaggrin deficiency. Filaggrin is a protein that plays an essential role in the skin's barrier function and hydration. It acts by binding the structural proteins in the outermost skin cells to form tight bundles and strengthening them to create a strong barrier.

Moreover, the processing of filaggrin protein leads to the production of molecules that form part of the skin's natural moisturizing factor, keeping the skin hydrated. These molecules also help maintain the skin's pH level, which is an essential aspect of the barrier.

Types of Eczema in Children

There are different types of baby eczema. It is important to understand the specific types for you to manage them properly. These include:

Atopic dermatitis

This is the most common type of baby eczema, and it affects about 13% of children in the US. Atopic dermatitis is also referred to as atopic eczema, and it starts in infancy or early childhood and commonly affects children with a family history of atopic dermatitis, asthma, or hay fever. Common symptoms include rash, and itchy and dry skin.  

Seborrheic dermatitis

This form of eczema is commonly referred to as cradle cap. Seborrheic dermatitis is not an allergic reaction like the other forms of eczema. It tends to affect areas of the skin with more oil-producing glands like the scalp, nose, and back.

In infants, it mainly appears on the scalp, but it can also cause a rash around the eye and nose areas. In most cases, the cradle cap goes away once the baby gets to 6 - 12 months of age.

Contact dermatitis

Contact dermatitis is an allergic reaction when the skin comes in contact with a substance that irritates the skin. The skin becomes irritated or inflamed after such contact. Unlike other forms of eczema, contact dermatitis is not genetic. Neither is it associated with other allergic conditions such as asthma and hay fever. Symptoms include a red rash on the skin and a burning sensation. 

Dyshidrotic eczema (foot-and-hand eczema)

This type of eczema is not common in children. Flare-ups only happen on hands and feet, and it presents in the form of a small itchy rash on the palm, soles, and edges of fingers and toes. Several factors are said to cause flare-ups of dyshidrotic dermatitis, including nickel, stress, and sweaty palms.

Other types of eczema include nummular eczema and stasis dermatitis (venous eczema), which this article will not discuss because rarely affect children. This article will focus mainly on atopic dermatitis because it is the most common form of eczema that affects babies. 

What are the possible causes of baby eczema flare-ups?

Due to the weakened barrier function of the skin, allergens can penetrate the outer layers of the skin and are picked up by cells from the immune system, causing sensitization. This then results in eczema flare-ups. Different triggers cause eczema flare-ups depending on the environment of the baby. Common triggers include:

Food allergies

According to Seattle Children's, 30% of children with eczema also have food allergies. The most common food allergy is cow's milk allergy. Children with cow milk protein allergy can experience itchiness and rash when they take dairy products.

Extreme temperatures

Some children have flare-ups during winter when the air is cold and dry, while some have a hard time during summer when it is hot.

Irritants 

Irritants such as strong scents, detergents, and pollen are likely to cause flare-ups in children with eczema. 

Filaggrin deficiency

Dry skin can be the result of filaggrin deficiency. Due to the breached skin barrier, irritants can cause dry skin, and worsening eczema.

Other triggers include animals, heat and sweating, skin infection, and saliva from drooling can also cause a rash on your baby's cheeks, chin, and neck. 

How can parents recognize eczema in babies?

Eczema flare-ups occur due to overreaction of the immune system when an allergenic substance comes into contact with the body. The immune response then produces inflammation and a rash on the skin. As mentioned earlier, the symptoms will usually depend on the form of eczema that your baby has, but most eczema forms have overlapping symptoms.

The following are the common symptoms of eczema in babies: 

Recurrent flare-ups of severe itching cause children to scratch the skin, causing more inflammation and damaging the skin barrier. In fact, some dermatologists say that “if it's not itchy, it's not eczema.”

Rash: Most eczema skin conditions are characterized by the appearance of a rash on the body. Sometimes the rash might ooze, weep fluid or bleed when scratched. When the rash is painful, it is likely because of a skin infection. 

Dry skin is caused by the weakening of the skin barrier function, leading to excessive moisture loss, leaving the skin dry.

Redness and swelling of the skin is caused by inflammation and are a result of excessive scratching of the skin.

However, symptoms of eczema might overlap with those of other skin conditions. It is crucial that you consult your doctor for a proper diagnosis. Once you have a clinical diagnosis of baby eczema, you can start treatment and management. 

Treatments for children with eczema

It is important to know the baby's symptoms and triggers for you to manage eczema effectively. There is no cure for eczema yet. Therefore, management measures are aimed at reducing skin inflammation and itchiness and preventing infections.

Several treatments are available for use in the management of baby eczema. These include over-the-counter (OTC) remedies, prescription topical medications, phototherapy, and immunosuppressants.

At-home management of eczema in babies

The first step in managing eczema is knowing your baby's symptoms and the factors that trigger flare-ups. If you are not sure whether the rash on your baby's skin is eczema or another skin condition, consult your pediatrician to get a diagnosis. The type of treatment depends on the severity of the eczema.

For mild eczema, using moisturizing creams and avoiding substances that trigger flare-ups is usually enough to clear the rash. For moderate eczema, one might need to use steroid cream and bedtime allergy medicines.

Babies with severe eczema are prone to skin infections caused by Staph bacteria. They might need antibiotics for treatment in addition to the cream. For this reason, you should consult with your doctor to come up with the best management routine for your baby!

Children with eczema should be washed daily. However, they should not stay in water for long as it might cause their skin to dry. Apply moisturizer on their skin immediately after a bath.

For dry skin, moisturizing cream or ointment is preferred. Moisturizing creams create a barrier on the skin, preventing excessive loss of moisture. For itchy skin, steroid creams or ointments are helpful. Use mild unscented body and laundry soaps. Perfumed and antibacterial soaps could be unfriendly to a baby's sensitive skin.

If you have prescribed medication, use it as directed to ensure that your baby does not get flare-ups. Some doctors recommend bedtime allergy medication that is taken orally to control itching at night.

If the flare-ups are a result of food allergies, then you should avoid giving that food to your baby. Some of the foods that babies are commonly allergic to are cow's milk, peanuts, and eggs.

Dress your baby in comfortable cotton clothes. This will help prevent irritation caused by clothes rubbing on the skin. Also, avoid overdressing your baby as heat and sweat might cause flare-ups.

Keep your baby from scratching their skin as scratching can lead to worse inflammation and infections. Ensure that you trim the nails and put mittens on your baby's hands to help prevent scratching. 

Hypoallergenic formula for the management of eczema for babies with milk allergies

As mentioned earlier in this article, the best way to manage your baby's eczema is to know and avoid the things that cause eczema flare-ups. Although milk allergies are not common in children, about 2 - 3% of babies have milk allergies. Eczema is one of the common symptoms of Cow's Milk Protein Allergy.

Hypoallergenic formula is often recommended for babies that are allergic to milk protein. If you suspect that milk triggers eczema flare-ups in your baby, you should consult your doctor for a diagnosis. If your baby is at risk of a milk protein allergy, you will have to give them hypoallergenic formula instead of the standard formula at your doctor's recommendation.

Hypoallergenic formula is specifically formulated for babies who are at risk of being allergic to milk protein. Although hypoallergenic formula is made from cow's milk, the allergy-causing protein is broken down in a process called hydrolysis.

Hydrolysis breaks down the protein into smaller compounds that the baby can more easily digest. Consequently, the formula is less likely to trigger a potential allergic reaction when ingested.

There are different types of hypoallergenic formula. These are: extensively hydrolyzed, partially hydrolyzed, and amino acid-based formula. In the partially hydrolyzed hypoallergenic formula, the milk proteins are only partially broken down to make it more easily digestible for the babies.

But because the allergy-provoking protein is partially rather than fully broken down, these formulas tend to be more likely to produce an allergic response. On the other hand, the extensively hydrolyzed formula contains proteins that have been completely broken down into tiny compounds. Therefore, it is less likely to trigger allergic reactions.

Babies with cow milk allergies sometimes still react to extensively hydrolyzed formulas, and therefore this type of formula should not be used for babies that have been diagnosed with a cow's milk allergy. For such babies, amino acid-based formula are the preferred option. These formulas contain amino acids instead of milk proteins. Amino acids are the building blocks in proteins and, therefore, the simplest form. 

Brands that produce hypoallergenic formulas

There is a variety of hypoallergenic formulas in the market today, one of the most popular brands of HA formulas is HiPP. HiPP is a German formula manufacturer with many decades of experience in making organic baby food products.

People are increasingly concerned about the quality of food that they eat. Most consumers tend to prefer organic foods over non-organic food products. Most people avoid GMO food products and favor products that are certified organic.

The major difference between organic and non-organic formula is that organic formula is made according to strict regulations on organic production. This, among many other benefits, means that the products do not contain any GMOs, and farmed ingredients are grown without the use of hormones or pesticides. 

The regulations require that organic food products be made using certified organic ingredients and certified processing aids. This means that some conventional processes are not allowed in the production of organic food products. For instance, the use of conventional fertilizers, pesticides, and antibiotics for livestock is strictly limited.

HiPP HA formula for the management of eczema

HiPP HA contains partially hydrolyzed protein, which means it may not be suitable for all babies with a cow's milk protein allergy. HiPP HA infant formula is intended for babies from birth onwards.

This formula is rich in nutrients and minerals that are essential for the development of babies. HiPP HA contains galactooligosaccharides derived from lactose that promotes healthy intestinal flora. It does not contain artificial sweeteners. Instead, it contains organic lactose as the primary source of sugar.

HiPP Comfort formula for the management of eczema

HiPP Comfort is meant specifically for children who struggle with colic and constipation. About 40% of infants experience unspecific indigestion such as wind, colic, and constipation in the first months of life. Symptoms of unspecific digestion include excessive crying and discomfort.

HiPP Comfort is made to help prevent and soothe these symptoms. HiPP Comfort contains partially hydrolyzed protein, fats that have a unique structure mimicking the fatty acids in breast milk, and reduced lactose content. This makes it easier to digest and more easily absorbed by the body.

Both HiPP HA and HiPP Comfort contain DHA (Docosahexaenoic Acid) and Arachidonic Acid (AA). These are fatty acids that are essential for brain development, promote eye health, proper functioning of the heart, and reduce inflammation.

HiPP formulas are developed to mimic the structure and composition of human breast milk as much as possible. These formulas contain all the nutrients required by law, omega 3 and 6 fatty acids, human milk prebiotics, and probiotics, and are appropriately low in protein content, just like breast milk.

Prebiotics and probiotics are responsible for developing positive gut microbiota that promotes the maturation of the immune system and helps protect infants from infections.

Hypoallergenic formula vs. Plant-based formula for children with milk protein allergies

Some parents resort to using a plant-based formula, such as soy or rice-based formula for their children who are at risk of milk protein allergies. While soy-based formula might be slightly cheaper than hypoallergenic formula, it is not very useful for children who are diagnosed with a cow's milk protein allergy.

This is because babies allergic to milk are also likely to be allergic to soy protein. Studies show that 10% to 14% of babies who are allergic to cow's milk protein are also allergic to soy protein. 

There are also other concerns around using soy formula, including the health effects of phytoestrogens found in soy. Soy formula is not recommended for preterm babies. There is a high prevalence of osteopenia in preterm babies who feed on soy formula. Plant-based should only be used if medically necessary at the recommendation of a qualified health professional. 

As an alternative to soy-based formulas, hydrolyzed rice formulas are a plant-based option that is suitable for babies with a dairy allergy, such as BebeM's Organic Rice-Based Infant Formula. This formula is made with a base of 100% organic rice protein hydrolysate and is packed full of nutrients like vitamins A, B, C, D, and E, minerals, and essential fatty acids (DHA, ALA, and EPA).

At this time, hydrolyzed rice formulas are only being recommended as an alternative to infants with dietary restrictions such as lactose intolerance or a milk protein allergy. Always make sure to speak with your pediatrician first before making any changes to your child's diet. 

Hypoallergenic formula vs. goat milk formula for children at risk of cow's milk allergies

It is a common misconception that goat milk formula is a good alternative for babies with cow's milk protein allergy. However, goat milk formula is not a suitable alternative to cow's milk formula for babies with, or at risk of milk protein allergies.

Sadly, babies who are allergic to cow's milk are also allergic to goat milk in most cases. This is because the allergy-causing protein in cow's milk is also present in goat milk.

Although the protein content is lower in goat milk, it is still likely to trigger an allergic reaction like eczema. Goat milk is easy to digest due to its fat structure and might benefit babies with very mild sensitivity to milk but not babies with milk protein allergies.

For babies who have clinically diagnosed milk allergies should not be given goat milk formula. 

When to call a doctor

Eczema is easy to manage from home by implementing the measures like daily baths and moisturizing over-the-counter remedies, topical prescription medication, and avoiding food that triggers eczema. However, if the skin condition does not get better after one week of using over-the-counter treatments, you should go to the doctor for a prescription.

You should consult your doctor if your baby develops blisters filled with pus on top of eczema. This might be due to a bacterial infection for which your baby might need antibiotics. This is also the case if your baby develops a yellow or light brown crust on the skin.

You should call your doctor if your baby comes into contact with a person who has cold sores or genital herpes. Due to the impaired barrier function of the skin, eczema makes your baby more susceptible to these infections.

If the baby develops a fever, appears very sick, if the eczema is painful when touched, or if itching flare-ups occur too often, you need to see a doctor.

Takeaways

Eczema, may appear and act differently as your child grows. It's essential to understand which type of eczema they may have, their symptoms, and triggers to better treat and manage it as they grow and change. The only way to be sure what type of eczema your child has is to consult your doctor for a diagnosis.

Moisturizers that contain ceramides are often used for the management of atopic eczema. These are available over the counter and by prescription. Generally, a good moisturizer, fragrance-free cream, or ointment such as petroleum jelly, will help your baby's skin retain its natural moisture when used several times a day. Apply immediately after a bath.

For children with eczema whose flare-ups are triggered by cow milk protein, hypoallergenic formula is usually recommended. Hypoallergenic formula is specifically formulated to help prevent allergic reactions in babies.

HiPP HA and HiPP Comfort are some of the best hypoallergenic formulas on the market. They are organic, contain only carefully selected ingredients, and have nutritional profiles modeled after breast milk. HiPP Comfort is tailored to help soothe babies with colic and constipation.

Please note that partially and extensively hydrolyzed formulas are meant to prevent cow's milk protein allergies in babies who are at risk of them. They are not appropriate for babies who are already diagnosed with such allergies. In this case, you may want to look at amino acid-based formulas.

References

1. Johns Hopkins Medicine: Managing Eczema in Winter and Year Round: A Parents Guide. Retrieved from hopkinsmedicine.org/health/wellness-and-prevention/managing-eczema-in-winter-and-year-round-a-parents-guide
2. National Eczema Association: What is Eczema? Retrieved from nationaleczema.org/eczema/
3. Rodríguez E, Baurecht H, Herberich E, Wagenpfeil S, Brown SJ, Cordell HJ, Irvine AD, Weidinger S. Meta-analysis of filaggrin polymorphisms in eczema and asthma: robust risk factors in atopic disease. J Allergy Clin Immunol. 2009 Jun;123(6):1361-70.e7. doi.org/10.1016/j.jaci.2009.03.036
4. Liang, Y., Chang, C. & Lu, Q. The Genetics and Epigenetics of Atopic Dermatitis—Filaggrin and Other Polymorphisms. Clinic Rev Allerg Immunol 51, 315–328 (2016). doi.org/10.1007/s12016-015-8508-5