Everything you need to know about baby eczema

Around 1 in 5 newborn babies get eczema, a skin condition that usually appears as an itchy red or brown patch.

Dr Derrick Phillips, consultant dermatologist and British Skin Foundation spokesperson, says eczema happens due to an impairment of the skin barrier function affecting its ability to retain moisture, leading to dryness and irritation.

"Baby eczema typically manifests as dry, red patches on the baby's cheeks. There may be areas of broken skin and scratch marks," he says. "The presence of yellow crusting is a sign of infection and usually requires a course of cream or oral antibiotics. Over time, the eczema may spread to other areas, including the torso, hands, in front of the elbows, and behind the knees. Nappy rash can also develop."

Why do babies get eczema?

Eczema is a complex condition. It can be genetic, which means your baby may be more likely to have eczema if other family members have it. "It is also more common in families with a strong history of eczema, asthma, hay fever, and food allergies," says Phillips.

However, eczema also involves an overactive immune response to environmental factors such as heat, soap, pollen, or other irritants, which can cause flare-ups. Around 1 in 2 people with eczema have an additional genetic element - a difference in a skin protein called filaggrin - which leads to further problems in the skin barrier.

What’s the link between baby eczema and food allergies?

Food allergies can happen in any baby. Although babies with eczema have a slightly higher risk of allergy, lots of babies with eczema have no other food or cow’s milk allergies.

Cows' milk allergy, also called cows' milk protein allergy, is common in childhood. One of the symptoms of a cow’s milk protein allergy can be an itchy rash. Exposure to cow's milk may act as a trigger for eczema if a baby is allergic to it.

However, it’s possible for a child to have both a cow's milk allergy and eczema as two separate conditions that need to be treated as such. If you think your baby has a cow’s milk allergy, you should speak to your doctor.

How can you manage baby eczema?

Baby eczema is often managed with a type of moisturiser called an emollient. "Emollients soothe the skin by producing an oily layer that traps water beneath, locking in moisture and repairing the skin barrier," says Phillips.

"Hot baths and soaps should be avoided as they strip natural oils away from the skin, causing further irritation," he adds.

"Bath oils and soap substitutes should be used instead. Bath oils are added to bath water, and both clean the skin and coat it with a film of oil trapping moisture beneath. Soap substitutes will clean the skin without causing dryness. They do not foam and may take some getting used to."

However, it is important to use bath oils or soap substitutes that are suitable for a baby’s skin, which is extra sensitive.

"Some cases of baby eczema will not respond to emollients alone and will need to be managed with the assistance of your family doctor or dermatologist," says Phillips. "Short courses of low potency steroid creams may be required to soothe the skin and reduce the inflammation."

Which creams or lotions are appropriate for baby eczema?

It is important to consult your dermatologist, paediatrician, or family doctor before trying new products.

Ointments are heavy, greasy moisturisers and are the most effective at locking in moisture and repairing the skin barrier. "These contain less water than other types of moisturiser, and as a result contain fewer preservatives. Ointments can also be used as a barrier treatment for nappy dermatitis," says Phillips.

Creams and lotions have a higher water content than ointments, Phillips explains. This means they are absorbed more rapidly and require more frequent application.

Do babies grow out of eczema?

It is impossible to predict whether your baby will have eczema for life or not. Currently, there is no cure for eczema. For many babies with eczema, the condition will resolve, but in some babies the condition will be lifelong.

Eczema is a long lasting (chronic) condition with periods of flare and periods of remission, and most people with a history of eczema still have problems with dry and itchy skin.