Baby Eczema Causes and Treatment: A Parent's Guide

Perhaps a red, weepy patch has developed around your newborn's hairline. Maybe you've noticed crusty patches on the knees or elbows of your 6-month-old. Eczema can crop up—and be unsightly and bothersome—at any age, even infancy.

Between 15 to 20% of children deal with eczema, also known as atopic dermatitis. As if itchy, flaky skin wasn't bad enough, this chronic rash often ushers in food allergies, asthma, and other conditions, according to research. But new insights about preventive care, early intervention, and diligent maintenance are revealing that eczema may be more treatable, and the allergic progression less inevitable, than previously thought.

By equipping yourself to know the signs, you can be your child's own best advocate. Here’s everything we know about baby eczema treatments, prevention, and more.

Baby Eczema Symptoms

The thing is, every baby is a little bundle of highly sensitive skin, which makes it difficult to know whether you're dealing with eczema or just garden-variety irritation. But there are clues to look for.

Eczema can look different in infants than older children—and even different in newborns than older babies. In newborns, the rash usually appears on the face, scalp, or trunk, and patches tend to look red and weepy. It typically creeps to the elbows and knees when a child is around 6 months old and friction from pushing up, rolling, and crawling can irritate these areas and give rise to eczema.

Baby Eczema Causes

Scientists are still working to fully understand the causes of eczema. Most doctors think that a combination of genetics and a child's surroundings make a baby vulnerable. Genetics and the use of certain products are known eczema risk factors.

Genetics

Studies show that children have a 75% chance of developing eczema if an immediate family member has had it. If a child's parent or sibling has ever suffered from eczema or allergies, it's especially important to bring that to the pediatrician's attention, says Sandy Skotnicki, MD, assistant professor of dermatology at the University of Toronto and author of Beyond Soap.

Personal Care Products

Babies's skin is 20% thinner than adults's skin. That means that they absorb skincare products more quickly and deeply, and their skin also dries out faster. We know that very dry skin can make a person who is susceptible to eczema more likely to develop it. Using excessive or heavily fragranced products on babies can set the stage for irritated, rashy skin.

Baby Eczema Link to Allergies and Asthma

A few years ago, when Alexandra Torres Fung's infant son started showing signs of eczema, a condition she shared, she thought she had it under control. She used gentle soaps, sparingly, and put tiny mittens on his hands at night to curb his scratching. But the red and pink patches on his cheeks still flared, and she found that dairy worsened the rash and made him fussy, too. Soon, he had allergic reactions to eggs and peanuts. "That's when I first learned that eczema is closely related to those allergies," says Torres Fung.

Research has shown that kids with eczema are vulnerable to a phenomenon called the atopic march, in which eczema gives rise to food allergies, asthma, and hay fever. According to a review of studies, up to 81 percent of kids with eczema go on to develop at least one food allergy. Meanwhile, one-third of children with eczema will develop asthma or hay fever.

Why is this so? "Essentially, atopic eczema is a skin-barrier disruption—leaky skin, if you will," Dr. Skotnicki explains. The skin is supposed to keep water in and irritants and allergens out. But eczema-affected skin fails to provide such a barrier, and its susceptibility to dryness and irritation can cause tiny tears that allow miniscule amounts of allergens to enter the body.

When these invaders make contact with skin affected by eczema, "the immune system freaks out and mounts a response," says Peter Lio, MD, clinical assistant professor of dermatology and pediatrics at Northwestern University's Feinberg School of Medicine in Chicago. That response can lead to an allergy to those foods or irritants—one that can last for the rest of the child's life.

Baby Eczema Diagnosis

Even if you suspect your baby has eczema, you may need to be persistent with doctors to get a diagnosis. Your child's pediatrician may refer you to a dermatologist. Because rashy flares can come and go, doctors typically ask a lot of questions to understand symptoms, and may diagnose eczema from this health history or, occasionally, a small skin biopsy.

Unfortunately, misunderstandings about the condition—and who is at greater risk—appear to be widespread among physicians. Many parents report that their child had to see multiple doctors before their eczema was diagnosed and treated. That delay can have long-lasting negative consequences. "Early diagnosis and intervention might help prevent certain aspects of the atopic march, and it certainly can ease severity," says Neeta Ogden, MD, an allergist-immunologist and spokesperson for the American College of Allergy, Asthma, and Immunology.

Another reason to tackle eczema earlier: Itching and rubbing can make the condition worse. "There's an increased risk of infection the more the itch-scratch cycle accelerates," says Ana M. Duarte, MD, director of dermatology at Nicklaus Children's Hospital and founder of the Children's Skin Center, in Miami.

Eczema in Babies of Color

According to data from the Centers for Disease Control and Prevention (CDC), about 17% of Black children and 10% of Latinx children in the U.S. have eczema and tend to experience more severe cases than white kids. The reasons for this aren't clear, but genetics, lack of access to specialists, and environmental conditions such as exposure in urban settings to dust, mold, and other allergens may play a role, says Dr. Ogden.

And know that the typical signs of eczema (such as red patches) show up differently in darker skin tones, says Dr. Duarte. Patches can appear darker brown, purple, or ashen in color, which doctors may miss, as Ayren Jackson-Cannady found when trying to get her baby diagnosed.

"My husband and I were shocked by how many doctors were so cavalier about it, saying things like, 'It's not red or inflamed, so it's probably just dry skin,' " Jackson-Cannady says. "They didn't seem to consider that Trey's brown skin might affect the appearance of eczema."

The American College of Allergy, Asthma & Immunology's site Eczema in Skin of Color raises awareness about racial disparities in atopic dermatitis. It offers information for patients and medical providers on how to better diagnose and treat eczema in patients of color.

Baby Eczema Prevention

The good news is that parents of little ones at high risk for eczema are not powerless. There are steps you can take that may help keep symptoms at bay and potentially halt the atopic march.

Limit Baths

"The first thing we need to do is stop washing children so much and for so long," says Dr. Skotnicki. "Water and soap break down the skin barrier we want to strengthen."

According to the American Academy of Pediatrics, three short baths a week during a baby's first year are probably plenty. They should last only five to ten minutes, and you should use a mild cleanser without additives. "Patting, not rubbing, your child dry and moisturizing within three minutes after the bath are also key," Dr. Skotnicki says.

Expose Babies to Allergens (Under Doctor Supervision)

Another counterintuitive—but clinically proven—strategy for halting the atopic march: early exposure to peanuts. When children between 4 and 6 months old who are at high risk for eczema start consuming peanut products, their chance of developing peanut allergies plummets by 74%, a major study concluded.

"You want a child's first exposure to common allergic foods to occur via the gastrointestinal tract, not the skin," Dr. Lio says. "When a baby ingests a food, the gut has special systems designed to induce tolerance so they won't become allergic. That doesn't happen with skin exposure." In short: The goal is to get common allergic foods into your baby's belly before they can wreak allergic havoc by being absorbed through the skin.

Of course, this should only happen with a pediatrician's okay. For babies who already have severe eczema or a family history of the condition, nuts need to be introduced only under an allergist's guidance. For babies at risk for eczema or who are already developing signs of it, it's always a good idea to reach out to a doctor early to make sure your prevention and treatment strategies are keeping your baby safe and helping them feel better.

Baby Eczema Treatments

There is no cure for eczema. "Daily moisturizing and proper cleansing are the cornerstones of eczema therapy, and they do result in better outcomes," says Dr. Skotnicki. There are other helpful treatments worth discussing with your doctor, too.

Moisturizers

Using a dye- and fragrance-free emollient is key to controlling eczema. The problem? Researchers found that 83% of the best-selling moisturizers featuring a "hypoallergenic" label include at least one potentially allergenic chemical, and 45% that claim to be fragrance-free are not.

According to our doctor sources, the best bet is to choose "greasy" ointments and creams (high oil content more effectively keeps moisture in and irritants out) that feature the National Eczema Association Seal of Acceptance, such as CeraVe Baby Healing Ointment and Aveeno Baby Eczema Therapy Moisturizing Cream.

Topical Steroids

Corticosteroid cream has been the gold-standard treatment for eczema for more than 60 years. These creams, which you can buy over the counter, can soothe eczema by reducing inflammation, tempering immune system reactions, and temporarily narrowing blood vessels.

However, there is limited research that establishes the ideal potency and dosage for children, particularly babies. Be sure to talk to your child's doctor before using any over-the-counter hydrocortisone cream on your baby.

Steroid-Free Treatments

Some parents may be reluctant to use corticosteroids on their children because of possible side effects, such as thinning skin. Even if parents feel comfortable using the creams, doctors advise using them only during severe flare-ups and for a limited period. As an alternative, there are newer, steroid-free prescription treatments.

Dupixent, a steroid-free prescription injectable approved for kids ages 6 months and up with moderate to severe eczema, has been called a game changer by some parents and doctors. After 16 weeks of monthly treatments in combination with a topical corticosteroid, more than 75% of kids ages 6 to 11 with severe eczema showed a 75% skin improvement.

For babies and kids with mild to moderate eczema, there's also Eucrisa, a steroid-free prescription ointment that reduces symptoms by blocking the production of pro-inflammatory proteins called cytokines.

Torres Fung uses a combination of over-the-counter moisturizers and EpiCeram, a prescription nonsteroidal topical barrier enhancer, to keep her son's eczema flares at bay. Now 4 years old, he doesn't have problems with his skin on most days. As soon as her fourth child started showing signs of the skin condition at about 9 months, Torres Fung made an appointment to see an allergist, both to evaluate his eczema and do allergy testing. "Thankfully, his eczema never got quite as bad as his brother's, and it also went away sooner," she says.

She did exactly what Dr. Ogden recommends all parents do: "Catch eczema early, stay on top of it, learn all that you can about early peanut introduction, and, above all, don't hesitate to be proactive."