Infant eczema and cradle cap

Eczema describes a group of skin conditions in which the skin becomes inflamed and itchy. The most common type is atopic dermatitis. Although we do not know precisely what causes eczema, it is thought to be triggered by a combination of genetic and environmental factors.⁶

Baby eczema often appears within the first few months of life as flaky or crusty patches on your baby’s skin. If you’re unsure whether a rash is infant eczema or something else, consult your doctor to confirm. In many cases, babies tend to outgrow infant eczema. However, while treatable, baby eczema can be very disruptive for both babies and their carers. Therefore it’s essential to manage it well.²

Cradle cap is another condition in infants that involves irritated skin on the head and face. While cradle cap can often be confused with baby eczema,  the two conditions are different.²

The skin barrier in babies is more fragile than in adults, making them more prone to getting eczema. Loss of water leads to dry skin, allowing allergens and irritants to penetrate the skin more easily. To get relief from itching, babies rub their skin, and this leads to further skin breakdown and rashes.³

Eczema occurs due to the body producing too few ceramides, which are cells that are rich in fat. Having too few of these cells results in skin that can’t retain water and so becomes very dry.²

There seems to be a genetic component to eczema. Similarly, infant eczema also tends to run in families. So if a parent suffers from eczema, then it’s more likely that a baby will have it too.²

Eczema can present with a range of symptoms, including itchy, inflamed, flaky, crusting and dry skin. In more severe cases, there can be blisters and scaly, crusty patches that ooze a clear fluid. In infants, this is predominantly on the face and scalp, but it can also occur in other areas. For example, the arms, legs, chest and back. Since eczema breaks down the skin barrier, there is an increased risk for infection in areas of skin with the condition.⁶

Baby eczema may not look the same on one baby as it does on another. For instance, in infants with baby eczema who have darker skin, the rash that appears may look brownish, purplish or greyish. Therefore, seeing eczema on babies with darker skin may be more challenging. In light-skinned babies, the rash often appears as patches of red skin. The patches are commonly rough, itchy and dry.²

Infant eczema can appear on almost any part of your baby’s body, but commonly appears on the joints of the limbs and the cheeks. If there is crusted, scabbed-over skin that is broken, you should seek medical advice because this could be a sign of bacterial growth.^2,3

Baby eczema may also cause your baby to rub their cheeks or other body parts frequently or to be irritable or fussy for no apparent reason.³

What is the difference between infant eczema and cradle cap?

There are some notable differences between baby eczema and cradle cap. With cradle cap, the affected areas are mostly on the scalp, behind the ears and along the sides of the nose. Likewise, the eyebrows and eyelids are often affected. The cradle cap is neither painful nor itchy, but it causes crusty or scaly patches that can lead to thick scales. The condition usually resolves by the time the baby is around eight months old.^2,4,5

Symptoms of eczema may be very similar to those of other skin conditions. Consult your baby’s doctor to make sure which condition your child has. This is important as it will obviously determine the treatment.⁴

To correctly diagnose infant eczema, the doctor will perform a physical examination and take a complete medical history. A patch test may be done to determine whether your baby has infant eczema or another skin condition. The test may also help determine if the eczema is caused by family history or environmental triggers. Sometimes it may be a mix of both.^4,6

While eczema and cradle cap are different, unrelated conditions, they often occur in babies simultaneously.⁴

A skin rash that itches can make life miserable, often disturbing a baby’s sleep. Constant itching and irritation caused by baby eczema can wake an infant during the night. Thus disrupting both the child’s and the parents’ sleep. Lack of sleep is, of course, frustrating and stressful for everyone involved.³

The good news is that by the time children are between three and five years of age, they most likely will have outgrown their infant eczema.¹

Tips to help prevent or lessen the irritation that leads to baby eczema:

• Keep your baby’s nails short, so they don’t scratch the rash.
• You can use cotton mittens at night or when the baby sleeps to avoid constant scratching.
• Choose cotton baby clothes; avoid trimmings that may be irritating, like lace or other scratchy or rough materials.
• Wash clothes in detergents that are free of harsh chemicals and fragrances.
• Double-rinse clothes.
• Avoid using dryer sheets as these may contain chemicals that cause irritation.
• Certain foods may trigger eczema. Mothers who are breastfeeding might want to note whether their baby experiences more breakouts after eating particular types of food. Babies being fed formula should preferably stick to one formula.^1,3

When your child has baby eczema, it is essential they are bathed daily and that a moisturiser is applied. Be sure to use a cleanser that is mild and non-irritating in a bath of warm water. Your baby should stay in the bath for no longer than 15 minutes to avoid over-drying the skin, and they should be carefully rinsed of all cleanser. After a bath, using a soft cotton towel, pat the baby’s skin dry, and while the skin is still damp, moisturise with cream or ointment.¹

Petroleum jelly is one option, or a cream free of fragrances or irritants. Always test the effects of a new moisturiser or any skin care products on a small patch of skin to ensure it is non-irritating. Look for products that contain soothing, natural ingredients.^1,3

A product such as Dermikelp^®, which contains CEM-K, a natural active ingredient derived from seaweed, offers a range of effective creams, lotions, ointments, cleansers, shampoos and conditioners that are gentle enough for infants and have no side effects. Dermikelp^® is the natural alternative to cortisone creams and moisturisers (which can only be used for a limited time). While it is as efficacious as topical corticosteroids, Dermikelp^® is free from steroids and their associated side effects, so it can be used liberally and as often as needed.