Gentle Care for Baby Eczema

It is important to remember that eczema and its symptoms are different for everyone. Eczema almost always includes itchy skin. At times, the itch can get so bad that it causes people to scratch - also known as the “itch-scratch cycle”.

What to look for:

• Itch

• Dryness, sensitive skin

• Inflamed, discolored skin

• Rough, leathery, or scaly patches of skin

• Oozing or crusting

Your baby may have all or just a few of these symptoms. There may be times when symptoms go away, and other times when your baby has flare-ups. The best way to find out if your baby has eczema is to consult a healthcare professional.

References:
1. Atopic Dermatitis - National Eczema Association Atopic dermatitis- Symptoms and causes | National Eczema Association Accessed 9.28.22
2. Eczema - National Eczema Association Eczema Causes, Triggers & Symptoms | National Eczema Association Accessed 9.28.22
3. Eczema - American Academy of Dermatology Eczema types: Atopic dermatitis overview (aad.org). Accessed 9.28.22

The exact cause of eczema in babies is unknown. What researchers do know is that eczema in general is linked to a combination of impaired skin barrier function, environmental allergens and/or genetics. Up to 25% of babies and toddlers experience eczema, and an estimated 60% of people with eczema develop it during their first year of life.

Atopic March:

While there is no cure, eczema symptoms can be managed by identifying and avoiding things that cause flareups and establishing a daily skin care routine.

References:
1. Nemeth V, Evans J. Eczema. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/
2. Baby Eczema - National Eczema Association Baby eczema: causes, symptoms, treatment and more (nationaleczema.org). Accessed 9.28.22
3. Atopic Dermatitis Causes - American Academy of Dermatology. Eczema types: Atopic dermatitis causes (aad.org). Accessed 9.28.22
4. The Allergic or Atopic March - Asthma and Allergy Foundation of America Allergic March | AAFA.org

Goals of eczema treatment include relieving itch and moisturizing to help restore the skin's moisture barrier. Gentle skin care and generous use of moisturizers are considered first-line therapy formanagement of eczema symptoms.

Cleansers and Moisturizers
Moisturizers help replace lost moisture, help restore the skin moisture barrier, and help relieve flare-ups. It is important to continue a regular moisturizing routine even when your child is not experiencing a flare.

Bathing Tips
• Use lukewarm water to wash your child.
• Use a mild, non-drying, gentle cleanser,
• Gently pat skin dry — don't rub.
• Avoid body sponges and washcloths.

Moisturizing Tips
• Apply an emollient- rich moisturizer, to damp skin (within 3 minutes after the bath).
• If needed, apply prescribed medications first and then liberally apply moisturizer. Talk to your healthcare provider about the use of prescribed medications.
Over-the-counter Medications
Topical anti-itch creams containing hydrocortisone may help to ease symptoms for children over 2 years of age. Follow the directions on the label carefully. Do not use more often or longer than recommended
on the label or by your healthcare provider.

References:
1. Eczema in Babies and Children - American Academy of Pediatrics Eczema in Babies and Children - HealthyChildren.org. Accessed 9.28.22
2. Baby Eczema - National Eczema Association Baby eczema: causes, symptoms, treatment and more (nationaleczema.org) Accessed 9.28.22
3. Atopic Dermatitis Causes - American Academy of Dermatology. Eczema types: Atopic dermatitis causes (gad.org), Accessed 9.28.22

In the US, 19.3% of Black children have some form of eczema usually developing during infancy and early childhood¹. The risk for severe atopic dermatitis (AD) may be 6 times higher in black children compared to white children² and is also thought to be more treatment-resistant³. AD prevalence is 12.94% in Chinese children, very close to that of Japan and Korea⁴.

Eczema can look very different on darker skin tones. Eczema is commonly thought of a red, dry, and itchy rash – how it appears on lighter skin tones. But redness can be a challenge to detect on darker skin tones which may make diagnosis more difficult. On darker skin, patches may appear darker than the rest of the skin, looking purple, ashen grey, or dark brown^1,5,6.

Studies have shown that melanin-rich skin does not retain as much water as white skin⁷, which means that in general, black people are more likely to have dry skin. Although eczema can be found anywhere on the body, eczema on black skin is often found on extensor surfaces – like the fronts of the arms and legs³.

Other signs to look for¹:

• Very dry or scaly skin

• Intense itching

• Skin thickening (lichenification)

• Dark circles under the eyes

• Small bumps on torso, arms, or legs (called papular eczema)

• Bumps that develop around hair follicles and resemble goosebumps (called follicular accentuation)

Although eczema severity improves for some patients in adolescence, it can be a lifelong issue affecting performance in school. One US study found that Hispanic children were 3.4 times more likely to be chronically absent from school due to AD than non-Hispanic white children, and non-Hispanic black children were 1.5 times more likely to be absent due to AD compared to non-Hispanic white children⁸.

References:

1. Eczema on black skin - National Eczema Association. Eczema on black skin: pictures, symptoms and treatment (nationaleczema.org)

2. Ben-Gashir MA, Hay RJ. Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterparts.

   Br J Dermatol. 2002;147:920-925.

3. Brunner PM, Guttman-Yassky E. Racial differences in atopic dermatitis.

   Ann Allergy Asthma Immunol. 2019;122:449-455.

4. Guo Y, Li P, Tang J, Han X, Zou X, Xu G, Xu Z, Wei F, Liu Q, Wang M, Xiao F, Zong W, Shen C, Li J, Liu J, Luo Y, Chang J, Sheng N, Dong C, Zhang D, Dai X, Zhou J, Meng C, Niu H, Shi X, Zhang X, Xiang J, Xu H, Ran Q, Zhou Y, Li M, Zhang H, Cheng R, Gao X, Wang H, Gu H, Ma L, Yao Z. Prevalence of Atopic Dermatitis in Chinese Children aged 1-7 ys. Sci Rep. 2016 Jul 19;6:29751. doi: 10.1038/srep29751. PMID: 27432148; PMCID: PMC4949439.

5. American College of Allergy, Asthma and Immunology. New Website Spotlights Unique Differences of Eczema In People of Color - ACAAI Public Website

6. Atopic Dermatitis (AD) in Brown Skin - Eczema in Skin of Color.org Atopic Dermatitis (AD) in Brown Skin | Eczema in Skin of Color

7. Wan DC, Wong VW, Longaker MT, Yang GP, Wei FC. Moisturizing different racial skin types. J Clin Aesthet Dermatol. 2014;7(6):25-32.

8. Wan J, Margolis DJ, Mitra N, Hoffstad OJ, Takeshita J. Racial and Ethnic Differences in Atopic Dermatitis–Related School Absences Among US Children. JAMA Dermatol. 2019;155(8):973–975. doi:10.1001/jamadermatol.2019.0597

Eczema is a chronic condition, which means that it cannot be cured1. Treatments, however, are very effective in reducing the symptoms of itchy, dry skin. Goals of treatment include relieving itch, and moisturizing to help restore the skin moisture barrier.

Some children outgrow their eczema. Others continue to have eczema flares and remissions for life. If your child’s eczema becomes more severe, your child’s doctor will consider other treatment options to manage symptoms and help prevent flares. The treatment plan will be tailored to your child’s individual eczema symptoms1. Tips for managing flares include2:

• Knowing triggers so that you can avoid exposure.

• Sticking with a daily bathing and moisturizing routine

• Using OTC creams, balms, and prescription medications when needed, consistently and as prescribed.

References:

1. Can eczema be cured? American Academy of Dermatology: Can eczema be cured? (aad.org)

2. What is eczema? National Eczema Association: https://nationaleczema.org/eczema/