They say the best offense is a good defense. The best way to treat eczema is to prevent flares from happening in the first place. Working to eliminate triggers is helpful, but keep in mind that an eczema flare can happen hours to a day after an exposure.
How To Find and Avoid Your Baby’s Eczema Triggers
Soaps are one of the most common eczema triggers. Hand soap, shampoo, bubble bath and body wash — even the ”all-natural” ingredients in these soaps (fruit extracts) can irritate skin. Household products may also contain isothiazolinone, an antibacterial, or cocamidopropyl betaine, used to thicken shampoos and lotions, which can both irritate the skin.
- Avoiding bubble bath and body wash, especially those with sodium lauryl sulfate
- Sticking to a simple soap like Dove
- Using fragrance-free products
- Avoiding bath oils and additives which are very drying
- Avoiding chemical/soap-based baby wipes, if possible
Clothes are worn all-day long, and can be a major source of skin irritation. Eczema triggers in clothing can come from laundry detergent, fabric softener, or dryer sheets and the fragrances in all of them.
Certain fabrics such as wool and polyester, and dyes found in leather, can also irritate the skin.
- Washing clothes in a soap like Charlie’s Soap and avoiding fabric softener or dryer sheets
- Wearing lightweight cotton, including socks
- Sleeping in cotton sheets
- Washing clothes regularly to remove oils, dirt, etc.
We think of air mostly as something we breathe, but the air carries pollens and molds onto every surface in our house including carpets, sofas, and bed sheets.
Pollen in the air can trigger eczema or make it worse. So can dust mites, pet dander from cats and dogs, mold and dandruff.
- Having an allergist test your baby for allergies to environmental pollens, etc.
- Using air filtration systems in your house
- Cleaning regularly to remove excess dust mites
- Washing sheets and pillow cases regularly to remove pollens
If food allergies are triggering eczema in babies, foods to avoid are the same top 8 that cause food reactions - dairy, eggs, peanuts, tree nuts, wheat, soy, fish, and sesame. It has been noted that in patients with certain pollen allergies, some foods that come from trees with those same pollens can cause eczema-like symptoms.
Below is a chart of the cross-reactivity between environmental allergens and foods:
- Having your baby tested for possible food or environmental allergies
- Trying an elimination diet where all possible triggers are removed and then added back in one at a time
Babies with eczema become itchy, or experience a “prickly heat” sensation when they sweat or get too hot. While parents always want to make sure their baby is warm enough, a baby that is in too many layers will sweat. During the drier months of the year, your baby’s skin may also get dry more easily.
- Daily use of moisturizers that protect and heal the skin barrier
- Only dressing your baby in one more layer than yourself
- Removing your baby’s hats and gloves when indoors
Strengthening Your Baby’s Skin Barrier
One of the best ways to prevent baby eczema flares is to strengthen your baby’s skin barrier. Using an emollient morning and night, and perhaps after washing hands, is a great way to seal your baby’s skin and prevent excess moisture loss.
Using products with a petrolatum base such as Aquaphor or products that help the integrity of the skin surface, such as CeraVe, can be useful.
How to Treat Baby Eczema Flares When They Happen
Part of the chronic nature of eczema is that flares will still happen occasionally despite your best efforts. The goals of any eczema treatment are to:
- Stop the itching by removing triggers or removing the histamine
- Prevent infection of the skin
- Heal skin irritated by scratching
Stop the itching
To stop the itching, you have to remove the histamine in the skin and ideally stop the body from producing more.
Topical steroids like hydrocortisone cream can be spread thinly over the affected area — a fingertip of cream is enough for an area double the size of your hand. The strength varies from over-the-counter creams with 0.1% or 1mg hydrocortisone in each gram of cream, to prescription-strength creams with 2.5% or 25mg hydrocortisone in each gram of cream.
Always ask a doctor before using hydrocortisone creams on babies to treat their eczema, and generally avoid areas around the eyes, around the bottom or genitals, or on broken or infected skin.
Don’t use hydrocortisone cream on the same spot for longer than a week. Long-term use of topical steroids has been associated with thinning of the skin, so it should only be used until the flare is under control, and only at the lowest strength needed.
For babies and children whose eczema cannot be controlled with topical steroids, a group of medications called immune modulators such as Protopic Elidel may be needed. Other newer medications include phosphodiesterase 4 ( PDE-4) inhibitors, such as Crisaborole, which can be used on children as young as 2 years.
Lastly, many allergists may recommend the use of daily antihistamines in children - not babies. Antihistamines basically help to alleviate the itching sensation. They do not stop the triggers, but they do stop the scratching. There is no significant long-term effect of daily antihistamine usage. Commonly-used antihistamines for eczema include hydroxyzine, cetirizine, and Benadryl (diphen hydramine).
The main concern with these is drowsiness. Therefore, you should be judicious in your usage. If a child has difficulty sleeping due to exacerbation of eczema, administration of a low dose of melatonin before bedtime might be considered.
Prevent Infection of the Skin
In persistent eczema where your baby is scratching their skin, doctors are often concerned that the normal bacteria that live on the skin will get into the cuts and cause an infection. Infections are dangerous and can prolong the itching-scratching cycle.
Bleach baths are often recommended as a way to stop a staph aureus (staph a) infection. Studies have shown that babies with eczema who develop a staph a infection are much more likely to develop food allergies.
To safely give your baby a bleach bath:
- Use 6 percent bleach for the bath. Do not use concentrated bleach.
- Add one teaspoon of bleach per gallon of water. For reference, bathtubs can hold anywhere from 40 to 80 gallons of water.
- Never apply bleach directly to your child’s eczema.
- Soak for five- to 10-minutes.
- Pat your baby’s skin dry, apply any medications, and then moisturize the skin
Heal the Skin, Trap in Moisture
The best way to heal the skin is to "soak and seal."
Soaking the skin can be done in a warm bath or shower that lasts at least 10-15 minutes:
- Wash the skin with a gentle soap like Dove without excessive scrubbing.
- Then dry the skin by gently patting it rather than rubbing.
- Finally, “seal” the skin with a moisturizer that is applied within three minutes of the bath. Ointments and creams are recommended instead of lotion for babies with very dry skin due to eczema.
The most popular sealers are:
- 100% pure petroleum jelly
- Vanicream Moisturizing Skin Cream
- Cetaphil® Eczema Soothing Moisturizer
- CeraVe Moisturizing Cream
Wet wrap therapy is a more intense way to soak and seal the skin. Wet wraps are done after bathing, applying any medication, and moisturizing. The affected area is wrapped in a slightly damp strip of clean cotton or gauze. Then, a dry layer is put over the damp layer to keep the dressing in place.
Wet wraps are left on overnight. If the eczema is on the feet and/or hands, medical gloves or food-grade plastic wrap can be used as the dry layer.
Will my baby’s eczema go away?
If you can stop flares from happening, then your child will look and feel no different than a child without eczema. It is possible to keep flares from happening such that your baby is essentially eczema-free. However, the underlying disease will always be there.
There is currently no way to cure eczema, though about half of infants with atopic dermatitis will eventually outgrow it.