The best ways to treat and minimise your baby's eczema
Skin expert Dr Sharad Paul offers advice and relief for parents with itchy babies.
Here’s an intriguing fact: the word ‘eczema’ is derived from Latin and Greek words that mean ‘to boil’. Treating it is almost like fighting fire – sometimes we use water (moisturiser), at other times we can smother it (using barrier creams like petroleum jelly), we prevent the fire (avoiding soaps and itching) and sometimes we use fire extinguishers (medications to control infection or itching). But while having a baby with eczema can be worrying, there are many things you can do at home to help manage your baby’s skin and to reduce the risk of flare-ups and infection.
In the womb your baby floats in amniotic fluid, so why doesn’t the skin wrinkle as it would if we were constantly in a bath? It’s because of the vernix – a waxy coating that protects your baby from the amniotic fluid. Once your baby is born and exposed to room temperatures, it’s natural for their skin to peel a bit. Some babies are more prone to this dryness which can then lead to eczema.
Fundamentally, managing eczema is managing dryness and keeping skin moist. Avoiding soap helps here because with its high pH level, soap tends to dry skin out. Amniotic fluid has a pH of 7.0 to 7.5; a baby’s skin has a pH of about 6.5 (and as we get older it gets even more acidic decreasing to around 5.5, especially at puberty, to prevent skin infections). Soap is essentially alkaline with a pH of 9 or more and therefore is not good for skin, especially baby’s skin. From the point of view of your baby’s skin, there’s nothing good about soaps – even ‘moisturising’ ones.
Bubbles are fun, but bubble baths can actually cause eczema flare-ups. Most foaming products use chemicals such as sodium lauryl sulphate to create the bubbles. Sodium lauryl sulphate is basically a surfactant, a compound that reduces surface tension and makes the bubbles more stable. The more bubbly a bath lotion, the worse it can be for your baby’s skin, but there are other ways to make bath time fun, such as using bath toys and waterproof books!
For babies who are prone to eczema, reducing both water temperature and time in the tub will also help. Bath water should ideally be the same as our body’s own temperature (37°C or 98.6°F). If your baby is used to hot baths, reduce the water temperature gradually. It’s best to limit your baby’s bath time to 10 minutes or less. Too much water contact strips your baby’s skin of its natural oils and causes the skin’s surface to break down, leading to inflammation which can then aggravate eczema. Also, never scrub your baby’s skin and just pat the skin dry after your baby’s bath. Rubbing skin can further aggravate eczema.
Sweating is a body’s natural response but it can aggravate eczema. Sweat contains salt and also trace elements of zinc, copper, iron, nickel, cadmium, lead and manganese, and the build-up of these chemicals in a particular spot can make eczema worse. As babies have more fat, sweat accumulates in the folds of their skin, such as elbow and knee creases, and that’s why your baby may get eczema more often in these areas. Furthermore, when the temperature is warm, our blood vessels open up. These vessels also carry inflammatory cells so it’s important to keep your baby cool. Tight clothes don’t ‘breathe’ so loose clothing helps with airflow around the skin. Synthetic fabrics breathe less than natural fibres, but also man-made fibres, such as polyester or nylon, are treated with thousands of harmful toxic chemicals during production. If your tiny tot is eczema-prone, it’s best to stick to cotton in summer. Any fabric (synthetic or natural) that claims to be ‘wrinkle-free’ will be treated with a chemical (usually formaldehyde) to make it that way, so is best avoided. If you take your baby swimming, saltwater is better than chlorinated pools.
As the weather becomes colder our skin tends to get dry due to the low humidity and temperatures. Humidifiers, which add moisture to the air, can help in some cases. While scientific studies haven’t actually shown that humidifiers make a big difference, many people find them helpful in controlling their baby’s eczema by preventing dry skin.
Itching is common in eczema, and scratching causes sleep disturbances in most babies and children. If your baby’s skin tends to dry out during the night, try wrapping a damp cloth around the affected area after moisturising. Leaving the wrap overnight can prevent the skin drying out and reduce the itch. You can also get mittens made of natural fabrics that will stop your baby from damaging his or her skin. Making bath time as close to bedtime as possible also helps reduce itch, as you can moisturise straight after a lukewarm bath. It’s also a good idea to keep a food diary and rate your baby’s skin daily. That way you’ll be able to identify any potential triggers in their diet. And here’s a great fact to remember: having fun helps eczema! Laughing and doing playful things increases dopamine, serotonin, endorphins and other chemicals that help reduce itchiness.
Recent studies show that some exposure to sunshine can help reduce symptoms of eczema, such as itchiness. Here’s how: sunlight stimulates a chemical in our skin that, in turn, activates specialised immune cells (the regulatory T cells) which reduce the ongoing inflammatory immune response. However, a baby’s skin is at greater risk of sunburn so it’s better to cover them up as much as possible until they’re at least six months old, and if they are exposed to the sun, it’s better to use a mineral sunscreen. Mineral sunscreens (typically containing zinc and titanium) are preferable to chemical sunscreens because they form a coating on skin and prevent sunburn. The National Eczema Association in the US recommends people look for a product with mineral-based ingredients such as titanium dioxide (TiO2) and zinc oxide (ZnO). It also recommends you make sure the product offers broad-spectrum protection (from both UVA and UVB rays) and has an SPF of 30 or greater.
Before deciding on what moisturiser to use, it’s important to understand what emollients actually do. Eczema causes dry, cracked skin and emollients seal the cracks and help skin retain moisture and become less damaged by irritants. Some creams increase the skin’s water content by attracting water vapour – these are called humectants. Glycerol is a good example of a humectant (products such as Sorbolene contain 10% glycerol). Aqueous cream should never be used as a leave-on emollient as it is likely to make eczema worse, rather than improve it.
Moisturisers, such as paraffin, Vaseline or petroleum jelly are emollients that prevent evaporation by forming a waterproof barrier on the skin’s surface. But because petroleum jelly can be sticky and messy, it’s best reserved for the trouble spots. While some people use lanolin, many babies can be sensitive or allergic to it, so it’s best avoided. Applying petroleum jelly to a new baby daily for the first six months of life may actually reduce their risk of developing eczema, according to a study by the Northwestern University Feinberg School of Medicine in the US. Those doctors looked at the cheapest and most effective moisturisers for eczema in babies. In this 2017 study, petroleum jelly scored the highest, followed by sunflower oil.
Finally, if your baby’s eczema has become infected or the itch is so severe that medication is needed, always consult your doctor.
|Dr Sharad Paul is a skin cancer academic, skincare expert, author and adjunct professor of the Auckland University of Technology. He is also a senior lecturer in skin cancer at the University of Queensland and has written many books for doctors and the general public on skin and wellness. Find him at drsharadpaul.co.nz.|
AS FEATURED IN ISSUE 49 OF OHbaby! MAGAZINE. CHECK OUT OTHER ARTICLES IN THIS ISSUE BELOW