My 5-month-old has always had facial eczema which her pediatrician refers to as a “mild” condition. We have been using an over-the-counter hydrocortisone cream every day. This is not much help. I am really reluctant to use any prescription cortisone creams since her face may get addicted to it. Even though it may be considered “mild”, her face hasn’t improved. Some days she scratches all over her face and the condition gets worse. The eczema is also on her legs. The eczema doesn’t seem to be improving. What can I do?
Liz Rajaram – Fremont, California
Dr. Greene’s Answer:
Eczema is one of the most common skin problems for children. It is a condition of dry, extra-sensitive skin. Most infants will outgrow it by the time they are 2 to 3 years old. Children who still have it will usually outgrow it by the time they become teenagers — just in time for acne (sometimes life doesn’t seem fair). If eczema runs in the family, it is more likely to be a lifelong condition. Even so, it is often worse in the first years of life.
Eczema is a vicious cycle! Something irritates your daughter’s skin, making it red and inflamed. It itches. She rubs it. The skin becomes more inflamed. The outer protective layer of the skin is lost. The affected area is extra-extra-sensitive to irritants, and dries out easily. She continues to be exposed to whatever it was that triggered the episode in the first place. Even more rash develops. The cycle perpetuates itself.
Many different things can be the irritating agent or trigger. Here is a list of common triggers to watch for:
- Rubbing the skin
- Moisture, such as saliva or milk
- Common housedust
- Wool or other scratchy fabric
- Dog or cat dander
- Cigarette smoke
- Clothes washed in irritating detergent
- Body soap
Occasionally, the eczema is caused by an allergic reaction to food or foods in the baby’s diet. In general, breast milk is tremendous for controlling eczema (in fact, 6 months of nursing can actually prevent eczema in some children). In some cases, if the nursing mom is consuming dairy products, nuts, eggs, seafood, or possibly other foods (which vary from individual to individual), the baby will be negatively affected. Foods children directly consume that can make eczema worse include cows’ milk, egg whites, citrus (such as tomatoes, strawberries, oranges, and lemons), chocolate, and nuts. If you are using a cows’ milk-based formula, you may want to try using a soy formula or another hypo-allergenic formula.
The first step in treating eczema is to identify the precipitating event or trigger and avoid it if possible! You may not see an immediate improvement, but if you are going to successfully treat eczema, it is important to break the cycle! Here are some tips:
- Avoid situations that will make your baby sweat — don’t pile on blankets or put her in a blanket sleeper.
- Cut cows’ milk, eggs, citrus fruits, and peanut products from her diet.
- Wash her clothes in a laundry detergent made for sensitive skin, such as Dreft Laundry Detergent.
- Avoid dressing your daughter (or yourself for that matter) in wool or any other harsh material (cotton is excellent).
To keep skin healthy, it is better to avoid long baths. We once thought that cutting down on all baths was important. Now we know that long baths and soaps are the problem for most children. When the skin prunes, this disrupts the moisture-retaining layer of sensitive skin.
Aim for frequent, brief baths, in lukewarm water, and use a small amount of very mild cleanser, such as Dove or Neutrogena, or better yet, don’t use any unless she is particularly dirty. These brief baths will hydrate the skin, not dry it out. A few children with eczema can’t tolerate baths at all and need to be cleansed with Cetaphil, a water-free cleanser for people with sensitive skin.
Apply a moisturizing lotion to the affected areas as least twice a day. Apply the moisturizer immediately following her bath, while she is still damp. Consider moisturizers that are hypoallergenic and fragrance free. Regular moisturizer use will keep the skin moist and help protect the skin from other irritants. A humidifier for the room can also help prevent the skin from getting too dry.
In the midst of an inflamed cycle, cortisone cream can be very helpful. It is not recommended for everyday use. Use the mildest form of cortisone that will break the cycle. On her face, an over-the-counter strength cortisone cream, such as Cortaid or Hydrocortisone, will usually be sufficient. Do not use anything stronger than the over-the-counter cortisone, unless prescribed for her by her pediatrician. Once the cycle is broken, gradually reduce, then stop, the cortisone over one week to prevent rebound.
If the eczema is not adequately controlled with the above measures, your doctor may prescribe an oral medication or stronger creams to control the itching. Even if you are prescribed medications for eczema, you should continue to apply moisturizers frequently since the foundation of any successful treatment regimen is consistent hydration of the skin.
You can help minimize inflamed patches of eczema, but her skin will remain sensitive until she outgrows the condition. A rash on your baby’s face invites you to look beyond the shallow covering of the outer layer of skin to see her true beauty that lies beneath.
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