Eczema Causes and Treatments

Dr. Greene discusses the causes and treatments of eczema in children with an emphasis on preventing flare-ups.


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
  • 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.
  • 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.

Recent studies show adequate Vitamin D and DHA, one of the important omega-3 fats found in breast milk, can help prevent eczema in young children.

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.

Last medical review on: January 30, 2015
About the Author
Photo of Alan Greene MD
Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Recent Comments

Most cases first develop in children under the age of five years. It is unusual to develop atopic eczema for the first time after the age of 20. At the moment, about 1 in 5 schoolchildren have some degree of atopic eczema. However, statistics show that it is becoming more common year on year. In about 2 in 3 cases, by the mid-teenage years, the flare-ups of eczema have either gone completely, or are much less of a problem. However, there is no way of predicting which children will still be affected as adults.

Ive always had cats and love on them . and i have eczema and i did every thing to stop the etching . Dr’s never know why i have it had it for years and yesterday i was watching my cat wash her self and i taught , when i read about eczema no one talked about having cats . i have only one cat now and started to wash my hands after loving on her and today my etching stoped and its healing up could that be the cause.

I have had severe eczema and have tried everything to heal my red, cracked, and weeping spots. Foderma serum… three days and red spots that I have had for years vanished.

My ten year daughter is having a particular red rash on her nose and it comes and go,I saw a month ago now it has come back pls is it normal

Pls my 5months old baby is having irritation caused by harsh soap on his skin,d skin is always dry,reddish,and some patches like eczema is on d skin too,am so worried,pls Dr reply.thanks.And pls will it go completely leaving his skin glowing like before?

Hi I had the same problem as yours since my baby 3mths old shes now 15mts .My specialist advised me using Qv bath oil and qv balm after shower to moisture the skin. It works well on her. Hopefully this eczema will go off as they grow older

foderma serum really helped control the eczema outbreaks on our daughter for the last 2 years. She never had severe cases, and the breakouts were limited only to her cheeks and elbow creases, but using foderma serum daily has, for the most part, prevented any breakouts. During extremely dry weather she still gets tiny eczema bumps, but not the big patches that she used to get prior to using foderma serum.

My facial skin has been tricky to care for since high school. It tends to be oily but if I fail to apply a moisturizer (either I ran out or I just forget) for a day or two and it will quickly dry up, leaving unsightly white patches on my face. Given that, it’s been quite complicated to get the right product. It had to be strong enough to fight the oil but gentle enough to not cause it to dry up. I’ve always craved for some kind of balance. I sought skincare products that had simple ingredients (that I could recognize much less pronounce). I chose all natural, organic brands that promised nourishing my skin without harsh chemicals. Some of the worked but were mostly broke the bank. Too expensive to maintain. Then I reached a point where I started to make my own. I googled recipes for herbal remedies and concoctions using ingredients from my own kitchen. Blah, blah, blah, there came Matcha Skin. I have always been in love with green tea and when I stumbled upon an article on Matcha, I was hooked. It’s like green tea on steroids. I love its absolutely potent anti-oxidant qualities and how it balances my skin. It fights the oil but never dries up my skin. Though it’s super natural, it’s not as expensive as the other more popular (but not so effective) brands. Because of its price, I didn’t hesitate to give it a try and I am so thankful I did. I have found it. No more trial and error looking for the perfect skincare line that works for me.

My new born has eczema a year ago when he was first born – I used the Made from Earth Valencia Orange lotion on it – its super gentle, and my baby has sensitive skin, and i worked well on his eczema. He had another breakout 6 months later, but we just applied the Made from Earth again, and it was gone in a week. Hope this helps!

Avoid scratchy materials in your clothing like wool – that makes my eczema flare up. Avoid harsh soaps too.

I suffer from bad eczema that can spread to my face and is unbearably itchy and sore. I noticed an improvement after just one application of Made from Earth Pure Aloe Vera cream – and I have also use this as an overnight moisturiser for my face which worked wonderfully for the eczema. So if you suffer from dry skin like I do, I wholeheartedly recommend it.

At 44 years old, I would still get excema on face, I have tried everything, and some thing work but somethings do not. For the last 3 months, I have been using the Made From Earth “Pure Aloe Vera Treatment” and yes. unbelievably it helped tremendously! I could not believe it. I threw away all my other creams and lotions. You can do it also – just keep trying things until you find the right product for you.

Hi. Can I consume red aloe vera if I’m breastfeeding my baby? Thanks.

My daughter is adopted from Vietnam and has sever Eczema. I am trying to introduce new foods and elimate others as a means to avoiding steroids. I am worried that the doctors are treating her as European rather than Asian, or am I being over sensitive. Is there anything that you could recommend that would help. She is 8 years of age.

Hey. I have been eczema since about more than a year. I wanted to know if cat hair and saliva can aggreviate it?? Pls answer thanks,

yes severely

what can I put on my 3 month baby head and face to stop him scratching him self as he cant stop rubbing it I have put mittens on him he is so itchy it’s breaks my heart I don’t know what else I can do. It started with cradle cap and now they have told me its exzma please let me know how to help him

Hi. My 6th mth old is also having the same problem and she’ll rub her face against our shirt. what I did to minimise the patches, itchiness and redness is that I’ll use cetaphil skin cleanser to clean her face. There’s a mild one suitable for baby. It really helped. After cleansing, I’ll apply breast milk using sterile cotton onto her face. If u dont have bm, coconut balm or aloe Vera gel works too. today is the 1st day I tried and it’s already getting better. :) and for the day I just keep her cool in aircon room. avoid the hot weather. Hope it helps.

If having excema or rashes, blisters, cracking painful skin: Please look at products and read about Methylisothiazolinone(MI) and methylchloroisothiazolinone (MCI) preservatives. Currently unregulated properly.
Both are strong skin sensitizers and severe contact skin allergens . Found in most liquid body washes including Restor a derm.
Dreftlaundry soap may also contain MCI/ MI or the variation ; benzisothiazolinone (BIT) as almost all liquid laundry detergents, fabric conditioners, dish soaps, cleaning products, shampoos, hair conditioners and household latex paints contain this cytotoxic biocidal broad spectrum preservative . You can ask to be patch tested by an alergist for the MCI:MI
(Cl+ME isothiazolinone ) allergy by skin patch testing and if positive, you will then be able to try and avoid all peoducts cobtaining thos serious allergen. The initial reactions often appear muchuke excema and dermatitis and goes misdiagnosed for years . Steroids will not cure this allergy.

“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”

It’s not allergic reaction, it’s called ‘food intolerance’ which should never be confused with allergies as there is a big difference between those two.

Food intolerance will not show on the allergy tests. Therefore, if your allergy test shows that you are not allergic to milk, you can still be intolerant to it, hence the eczema !!!

I wish my baby’s doctors knew that before I introduced milk back to his diet, maybe we could have avoid him suffering from severe eczema.