Managing eczema in babies

Common locations of eczema lesions in infants¹ ² ³

The usual sites for atopic dermatitis lesions in babies include:  

• The face, particularly cheeks, chin, and forehead.  
• The scalp 
• Limbs’ extensor regions, notably around the knees and elbows.  
• The anterior neck fold and area behind the ears, often exhibiting cracks and oozing.  

Eczema in babies typically avoids areas such as the palms, soles, nose, and diaper region. The pattern of lesions can vary among infants and often shifts to the flexural areas, like the inner elbows and knees, as the child grows. 
 

The emergence of atopic dermatitis in infants is influenced by a complex interplay of genetic, immune, and environmental factors.

Genetic factors

Eczema has a pronounced genetic predisposition. Research indicates that if one parent has a history of atopic conditions, including eczema, their child faces a 50 to 70% increased risk of developing the condition. Key among the implicated genes are those responsible for the production of filaggrin, a vital protein for maintaining skin barrier integrity. 

In infants with eczema, a deficiency in this protein and the resultant loss of the natural hydrolipidic film can lead to increased water loss through the skin. This disruption in skin barrier function, compounded by filaggrin anomalies, leaves the skin dry and more susceptible to penetration by allergenic substances, sparking inflammatory responses.

Immune system abnormalities

Infants suffering from atopic dermatitis exhibit an unusually reactive immune system. This hyperactivity is characterized by the production of excessive levels of IgE antibodies  in response to common environmental allergens.

Environmental triggers 

Environmental elements are critical in both the onset and aggravation of atopic dermatitis in infants. Everyday irritants, such as soaps, detergents, fragrances, and wool, alongside temperature fluctuations, can intensify eczema symptoms. Certain food allergens can trigger or exacerbate eczema in predisposed infants. Exposure to air pollution and tobacco smoke also contributes to the risk of developing eczema. 

Implementing certain practices is crucial for averting eczema flare-ups in your baby. 

Managing eczema in babies 

Adopt these measures to minimize skin irritation:  

1. Suitable bath products: use soap-free, liquid cleansers with a neutral pH and suitable lipid levels. Alkaline soaps can be overly abrasive for an infant's delicate skin.  

2. Moderate water temperature: aim for lukewarm water, ideally between 27 to 30°C, to safeguard your baby's skin.  

3. Limit bath time: Keep baths short, about 5 minutes, to prevent the skin from drying out. Bath oils formulated for infants can help retain moisture.  

4. Gentle cleansing: Clean your baby's skin gently to remove crusts and bacterial contaminants, especially if there’s a superinfection.

5. Soft drying and emollient application: Pat your baby's skin dry with a soft towel and apply an emollient while the skin is still damp to lock in moisture.  

6. Minimize environmental triggers: maintain a home environment with optimal humidity and a steady temperature around 18°C. Shield your baby from tobacco smoke and familiar allergens by ensuring proper air circulation.  

7. Avoid contact irritants: choose cotton clothing and steer clear of wool or synthetic fibers. Rinse clothes thoroughly and avoid fragranced fabric softeners. 

Strategies to prevent scratching 

These gentle methods can help alleviate itching and prevent scratching in infants:

• Use of thermal water: spritz thermal water on irritated areas for a soothing effect, followed by a moisturizing application.   
• The soothing effect of cold: cold can help alleviate itching. Consider using a chilled thermal water compress or a refrigerated cooling gel pack for temporary relief.  
• Wearing cotton gloves at night: for infants who scratch in their sleep, consider using small cotton gloves. This can help prevent accidental scratching and limit worsening of itching.  
• Keeping nails short: Keeping your baby's nails short and smooth can prevent accidental scratching.  
• Prepare for nighttime: apply an emollient cream before bedtime to reduce itching.  Ensure your infant's bed is equipped with soft cotton sheets, keep the room well-ventilated and the temperature around 18°C.