Contrary to popular belief, not all baby eczema is the same. Eczema is a condition where patches of skin get itchy and become red and inflamed. But there are actually 4 different types of skin conditions people refer to when talking about eczema.
The four types of eczema-like skin conditions are:
- Atopic dermatitis
- Contact dermatitis
- Dyshidrotic eczema
- Seborrheic dermatitis, otherwise known as cradle cap
However, only atopic dermatitis and seborrheic dermatitis are common in babies.
Almost always, when people think of baby eczema, they are talking about atopic dermatitis.
Atopic dermatitis (“derm” = skin, “itis” = inflammation) is the most common subgroup of eczema — so much so that some experts use the term interchangeably with eczema. 1 in 16 Americans has atopic dermatitis, and as many as 1 in 5 babies present with atopic dermatitis as some point.
Atopic dermatitis first shows its red, itchy self before your baby hits 6 months old, and usually stays around for the rest of your baby’s life. Atopic dermatitis, like all eczema, comes and goes such that sometimes your baby’s skin may seem totally normal, while other times it gets worse.
Most people’s atopic dermatitis goes away, lessens in itchiness, or shows up less frequently as they get older and learn to control the triggers.
Babies with atopic dermatitis are more likely to develop or also have asthma and hay fever (allergic rhinitis). A family history of asthma or hay fever also increases a baby’s chance of developing atopic dermatitis.
Atopic dermatitis is indistinguishable from “eczema.” It is characterized by flares of a red itchy rash. If the rash is scratched, the skin in the rashy area will become thicker, scaly, and may form deep lines from the scratch marks.
Atopic dermatitis may be triggered by an underlying allergy to dust, pollen, food etc, and it may be more likely to flare when your baby comes into contact with these. An allergist can help rule out environmental triggers of AD.
AD may also be caused by dry air, excessive cold, or heat, all of which can cause water loss through the skin. In these instances, regular moisturizing with an emollient may clear up or even prevent flares.
Lastly, daily use of antihistamines, or in severe cases, steroids, can also keep flares from happening.
Contact dermatitis is a form of eczema where red, itchy skin is triggered by contact with a chemical or substance.
Common triggers of contact dermatitis are nickel (in rings), soaps, and fragrances. Contact dermatitis is most often found on the hands, but can also be spread over the body if the trigger is something in clothing, a fragrance in a laundry soap, etc.
Contact dermatitis can be allergic or irritant, meaning the rash is caused either because of an underlying allergy to the chemical or simply a reaction to the chemical. In either case, management of contact dermatitis is as simple as not touching the trigger.
While contact dermatitis can happen in children, it is most common in adults and extremely rare in babies. Babies simply are not in contact with most triggers. Contact dermatitis is most prevalent in healthcare workers who wash their hands constantly, or laborers that work with their hands.
Many workers will don gloves to keep their skin away from the irritant, or finds cleaning products that are less drying. Daily or regular moisturizing of hands and areas that are affected is the most effective way to reduce the impact of symptoms.
Dyshidrotic eczema is a type of eczema that is known for the tiny, painful blisters that develop on the soles of the feet or the hands. The blisters can be extremely itchy, causing people to scratch until the area bleeds. People suffering with dyshidrotic eczema may have difficulty sleeping or working with their hands.
Like contact dermatitis, dyshidrotic eczema is rare in babies, but can develop in children. Most experts think that the hormones released from stress are a leading cause of dyshidrotic eczema.
Treatment for dyshidrotic eczema is a combination of moisturizing the hands each time they are washed, limiting stress, limiting environmental triggers, and regular use of antihistamines or immune-suppressing drugs.
Is Cradle Cap Eczema?
Seborrheic dermatitis, or cradle cap, is actually not eczema - though it can look a lot like eczema. Babies may get seborrheic dermatitis on their scalp or face, anytime between 2 weeks and 12 months old. It typically resolves on its own.
It is not usually itchy, which is a key difference between atopic dermatitis of the scalp and cradle cap.
Unlike forms of eczema, which are caused by skin that is too dry, seborrhea is caused by skin that is too oily. Therefore instead of avoiding baths and adding moisturizer, the treatment for seborrhea is treated by washing your baby's hair once a day with mild, fragrance free shampoo, adding petroleum jelly to loosen any scales, and then using a soft brush to gently remove excess skin.
If the condition worsens, your pediatrician may prescribe a mild steroid. However, almost all cradle cap resolves on its own.
We don’t know exactly what causes cradle cap. It's likely due to a combination of things, such as too much sebum on the skin, perhaps in combination with a harmless type of yeast called Malassezia.
The good news for parents is that eczema and cradle cap are fairly common, and are pretty easy to manage. It comes down to knowing and identifying the symptoms and treating them accordingly.