Eczema is a very common and treatable condition that develops in around 10 percent of all children. To treat more severe cases of eczema, your doctor may prescribe a topical steroid to help soothe and manage your baby’s eczema flare ups.
Eczema is an umbrella term that is used to describe a skin condition that causes the skin to become red, itchy, and inflamed. According to a 2014 report from the American Academy of Pediatrics (AAP), eczema affects at least 10 percent of children in the United States. 85 percent of these cases will develop before the age of 5 and children typically will develop atopic dermatitis.
Eczema with babies is not only very common, but very treatable. It is likely that your baby will also eventually grow out of it. There are two types of eczema: atopic dermatitis and contact dermatitis. Atopic dermatitis is an inherited form of eczema, so babies with a family history of allergies, eczema, or asthma are likely to develop this type of eczema. Contact dermatitis is a rash that develops only when the skin comes into direct contact with an irritating substance (such as pollen or pet dandruff) and will clear up once the element is removed.
Your baby’s eczema can appear anywhere on the body. These are the most commonly reported spots for eczema to show up on a baby.
- Birth to 6 months: flaky skin patches may appear on cheeks, behind ears, and scalp
- 6 to 12 months: common to appear on elbows and knees, might flare up as the children begins to crawl around
- Around 2-years-old: shows up on creases of elbows and knees, wrists, hands, and ankles
Learn more about eczema in children from the American Academy of Allergy, Asthma, and Immunology (AAAAI):
Eczema is caused by an overreaction of the immune system. While there is not one known, exact cause for eczema, doctors believe that there are multiple factors that can lead to the overreaction. Eczema is likely caused by a combination of both family genetics and environmental factors such as pollen or pet allergens.
If you have a family history of eczema or allergies, it is more likely that your baby will develop eczema. Around 20 to 30 percent of people with eczema have a genetic variation that makes it more difficult for their skin to retain moisture from a lack of fatty cells, also known as, “ceramides.” The skin can lose water more easily, become very dry, and have a difficult time keeping out foriegn substances.
Eczema is a very common and very treatable condition. If your baby does have eczema, symptoms will likely show up during the first few months. Fortunately, many children also come to outgrow their eczema.
Eczema will show up as patches of red skin or dry skin with an itchy, rough texture. It can show up anywhere on the body but will most likely be found on their cheeks, arms, legs, or scalp.
Eczema can be easily confused with cradle cap because the two have such similar symptoms. Cradle cap will appear less red and scaly and will only show up on the scalp, sides of the nose, eyelines, eyebrows, or behind the ears. Cradle cap will typically clear up by 8 months; if you are not sure what your baby is experiencing, talk to your doctor about their symptoms to determine whether or not it is cradle cap or eczema.
Triggers for Eczema
To help manage your baby’s eczema, there are a few things you should avoid that can cause eczema flare ups.
- Soap: avoid soaps that have added fragrance or perfumes. Use a gentle, fragrance-free soap when bathing your baby. Do not give your baby a bubble bath as this can cause major flare ups.
- Pollen: environmental factors, such as pollen, can cause a flare up. When outside, lay your baby down on a blanket or towel to avoid direct contact with the grass and outside allergens, as best possible.
- Animals: non-hypoallergenic animals may cause an eczema flare up. Try your best to avoid coming into contact with these animals.
- Food: avoid any food that you have noticed causes an eczema flare up. If your baby grows out of their eczema, you can reintroduce these foods.
- Wool: wool fiber or other scratchy, rough materials can irritate the skin. Avoid these rough materials.
- Dry Air: to help get more moisture into the air, try using a humidifier to help alleviate any eczema flare ups.
The main symptom of eczema is dry, itchy skin so using a thick, moisturizing lotion will be the best treatment for your baby’s eczema. To help soothe and manage your baby’s eczema also try the following tips.
- Short Nails: to prevent scratching and itching, keep your baby’s nails trimmed short. Sometimes, babies can itch the eczema patches at night so much that they begin to bleed. If you find that your baby is doing this, try putting mittens on your baby’s hands at night to prevent scratching throughout the night.
- Daily Baths: a short, daily bath can be helpful in soothing your baby’s eczema. Be sure to use lukewarm water and a gentle, fragrance-free soap. The bath should only be about 10 minutes long and do not run a bubble bath as this can cause a flare up.
- Moisturizer: give the lotion a few minutes to sit before dressing your baby. The best time to apply lotion is right after a bath while the skin is still damp. You should continue applying every few hours after.
- Topical Steroid Cream: if your baby’s eczema is severe, you may consider looking into a topical steroid cream to help manage and treat the discomfort. Consult with your doctor on if this would be an option you could look into.
Are Steroids Safe for Babies with Eczema?
Yes, a topical steroid cream is safe for your baby to use. You should consider a topical steroid cream if your baby’s flare up is lasting longer than 1-2 weeks. Work with your pediatrician to find the right steroid cream to use with your baby.
With the right prescription and proper use, steroids are safe for babies with eczema.
When Should Steroids Be Used for my Baby’s Eczema?
The topical steroids can be used to help make the eczema symptoms less painful for your baby. You will use the steroid cream to treat your baby’s eczema flare up and once the flare up clears up, you can stop using the steroid cream. In-between flare ups, continue to use lotion daily to help manage and soothe your baby’s eczema.
Doctors will typically recommend using the topical steroid daily, for at least a week. If your baby experiences frequent flare ups, you may want to consider using the cream 2-3 times per week on usual flare up spots, just as a preventative measure.
Types of Steroids for Babies
- Mild – hydrocortisone cream 1% This is often used to treat children. If this does not work after 3-7 days, patients may be prescribed a stronger steroid.
- Moderate – strength prescription topical steroid, (such as triamcinolone acetonide 0.1% cream) Use this as soon as your child has a flare, with red, rough, itchy skin.
- High – strength prescription topical steroid such as desonide 0.05% Ointment to be used as directed by your healthcare provider.
Note: Babies can also be prescribed two or more different steroids to be used at the same time. This is dependent on the different needs of the body. In addition to topical steroids, oils or other medicated shampoos, such as T/Sal, can be used to help treat scalp needs (for example, 0.1% Elocon solution or DesOwens lotion after each shampoo).
How Long Should I Use the Steroids?
The topical steroid should be used until the flare up goes away. This should take around a week of daily steroid cream application. If you find that the flare up is not going away after a week, consult with your doctor to look into other methods of treatment.
What Are The Potential Side Effects?
After the flare up clears up, you should stop using the topical steroid daily. There are potential side effects to topical steroids that will occur with frequent, daily use of the cream.
- Thinning of the skin
- Skin color can change
- Stinging sensation when applying
With long-term and frequent use of steroids, the steroid may get through the skin barrier and into the bloodstream. This can potentially affect your baby’s growth. If you are having to heavily use a topical steroid, work with your pediatrician to closely monitor their growth and development.
How To Use the Steroids?
Applying the topical steroid is easy with these following steps:
- Wash yours hands before putting it on
- Apply steroid creams after a bath, apply a very thin layer with FTU method (see below for more information)
- Wash hands after applying to your baby’s skin
- Coat steroid with an emollient (lotion)
- Apply the steroid only 1-2 times per day
How Much Should I Be Applying?
The amount you will be applying to your baby’s eczema flare up depends on the amount prescribed by your doctor. Never use more than what your doctor recommends and only apply the topical steroid to the eczema-affected areas. You should never be applying the steroid cream to your baby’s eyelids or genitals.
Once the flare up is under control, reduce the use of the topical steroid. Following the application, it is best to apply a lotion or moisturizer on top to coat the steroid cream and help it absorb into the skin.
Use the Fingertip Unit (FTU) method to determine how much of the steroid you should be using. FTU measured is the amount of topical steroid that is squeezed out from the standard tube along an adult’s index ginger to the first crease/line in the finger.
Image Source: National Eczema Association (NEA)
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