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?

Eczema on your baby's face is frustrating. It is, of course, far worse on the days she is scheduled to have her pictures taken or to see a distant relative. In fact, it is so bad that you wonder if it is all people see when they look at your darling little girl. You hope she'll grow out of it, but what if she doesn't?

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
• Overheating
• Common housedust
• Wool or other scratchy fabric
• Dog or cat dander
• Cigarette smoke
• Clothes washed in irritating detergent
• Body soap
• Water

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.
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