Eczema in babies

Eczema in babies



And just like that in the blink of an eye my youngest is nearly 8 months. Trawling through old videos and photos, I came across this video that was shot when I was pregnant with him. I am talking about eczema in the video and little did I know that he would also have infantile eczema, like his older sister (eczema tends to run in families). And little did I know I would have many a sleepless night with him scratching and irritable!

Today I was asked about suggestions for eczema management for a medical colleague’s baby. She was having trouble managing her 4 month old’s eczema. Here is the conversation, almost verbatim….

{Sleepless mum of 4-monther}  Eczema runs in my family. Bub has eczema and dribble rash and also heat rash on the trunk. He is scratching at night and I really want to help him. I have been putting on greasy moisturiser on the dribble rash and barrier cream containing zinc but I think this has made it worse. I have been applying bath oils in the bath, moisturising creams and 1% hydrocortisone cream for the body rash but am getting no where and no one in my house in getting sleep. HELP!

{Me} Don’t bother with 1% hydrocortisone on the body. This over-the-counter cream is really only for the mildest of eczema rashes. It does have its place but when the eczema is severe enough that no one in the family is getting any sleep, you need to bring in the medium/strong potency topical steroids for the body eczema. I would suggest topical steroids such as methylprednisolone aceponate 0.1% daily for about 2-3 weeks until the rash settles considerably and then downgrade to the 1% hydrocortisone for maintenance.

{Sleepless mum of 4-monther} But the 0.1% cream you’ve suggested must be weaker than the 1% hydrocortisone that I have been using.

{Me} This is a common misconception. The percentage that is displayed on the topical steroid cream does not in any way correlate with potency strength. It is a bit confusing but as dermatologists we are used to figuring out which potency strength patients are going to need to sort out their rashes. A lot of people ask me about steroid atrophy (thinning of the skin)  but if you apply the steroid cream only to the rash areas and not on normal skin, and apply for short periods of time to control the rash, you would rarely get skin thinning. You should go with your gut and if bub is unhappy and itching away, then he needs active cream treatments.

{Sleepless mum of 4-monther} What about his heat rash? I’m doing all the right things; avoiding overheating; using lukewarm baths…

{Me} Here are some additional things that you might want to make sure you are doing for the heat rash/eczema….If you have a mattress protector, consider ditching it for the short while until the rash resolves. Most mattress protectors will be quite “plasticky” and trap heat. As you have a young 4 monther that is not yet able to roll over, he might get too hot in the cot but he won’t be able to roll over or get himself in a more comfortable position. I have found with my 8 monther, once he was rolling and sitting up by himself, a lot of his eczema settled down as he is able to “air himself” out more. If bub co-sleeps in bed with you, he may also be overheated. Also if he uses a sleeping bag, try and opt for a light cotton one rather than a heavy duty style. Try and use 100% cotton sheets in bedding rather than poly/cotton blend to keep him cool, avoid any clothes that might irritate his skin – wool, clothes with irritating zips and tags (consider cutting off tags even!), ribbed singlets..

{Sleepless mum of 4-monther} **SMS’ me a picture of the heat rash**

{Me} ….bub’s skin does look irritated in the pic. I would also steer clear of occlusive ointments. So if you are using topical steroids, go for the cream preparation rather than the greasy ointment as ointments can be too “sticky” and make the heat rash worse. Get bub reviewed if the above don’t help. Sometimes eczema can become secondarily infected and then there might be a need for topical or oral antibiotics or anti-septic washes. Good luck! Most kids will grow out of eczema but hopefully by doing all of the above, you can make the transition easier….and hopefully get some more zzzzzz in the meantime.