What Is Baby Eczema?
Medically reviewed by William Truswell, MD
Baby eczema is an umbrella term for different types of dermatitis. This condition causes itchy, dry, discolored, and swollen patches on the skin.
Eczema can develop in infants as young as two months old. Most cases of eczema occur before the age of five, but it can develop later in life. The majority of children outgrow eczema by young adulthood.
Eczema is uncomfortable and itchy, and infants may make it worse by scratching. Avoiding triggers and treating symptoms, often with baby eczema creams and other at-home remedies, can help manage the condition and make babies more comfortable.
Types
There are several types of eczema. The following types are the most likely to affect infants and young children.
Atopic dermatitis: The most common type of eczema, which causes itchy, dry skin patches.
Contact dermatitis: Skin irritation that occurs when it comes into contact with an allergen. Unlike atopic dermatitis, it does not run in families.
Dyshidrotic eczema: A skin condition that causes small blisters on the palms of the hands, edges of fingers and toes, and soles of the feet.
Seborrheic dermatitis: Also known as “cradle cap," this condition causes yellow, greasy, flaky patches of skin that affect the scalp, face, or ears. It's caused by overactive oil glands or yeast on the skin. Unlike atopic dermatitis, it's not itchy and often resolves within the first year of life.
What Does Baby Eczema Look Like?
For infants less than one-year-old, eczema typically occurs on the scalp and face, often the cheeks and forehead. It also commonly appears on knees and elbows because these areas are continually scratched during crawling. It may spread to the chest or back, but it does not usually appear in the diaper area.
By two years old, eczema often appears in elbow and knee creases, on ankles, wrists, and hands, around the mouth, or on eyelids.
Symptoms of eczema in babies can come and go and may include:
Dry, itchy skin
Scaly or bumpy skin
Purple or greyish-brown skin patches on dark skin tones
Red skin patches on lighter skin tones
Blisters that leak fluid and crust over
Irritability and fussiness due to discomfort
Eczema can cause severe itching. The itching and scratching are often worse at night and can disrupt sleep.
What Causes Eczema in Babies?
Eczema is not contagious, but the cause of baby eczema is not yet fully understood. Experts believe it is a combination of genetic, immune system, and environmental factors.
Atopy
Immunoglobulin E (IgE) is an antibody the immune system releases in response to allergens. Atopy is a predisposition to conditions that produce IgE antibodies in response to normally harmless environmental substances. In other words, atopic diseases are inflammatory conditions caused by a reaction to a trigger that irritates the immune system. Infants with eczema may have an overactive or inappropriate immune response to irritants, causing skin inflammation, itching, and redness.
Atopic diseases have a genetic component. Infants who have a close family member with atopic disease (such as atopic dermatitis, allergies, or asthma) have a 50% likelihood of at least one type of atopic disease.
Weakened Skin Barrier
Some people with eczema have genetic mutations (changes in their DNA) that disrupt skin barrier function and immune response. If something compromises skin barrier function, the skin is less effective at keeping moisture in and foreign objects out. This can lead to dryness and itchiness. Scratching or rubbing can weaken the skin barrier even more.
Inflammatory Cycle
Baby eczema is itchy, which triggers the urge to scratch the area. However, scratching causes further irritation and inflammation. This creates a vicious cycle of itching and scratching that can lead to skin damage and cause lichenification—scarring and darker, thicker, leather-like skin.
Risk Factors
Atopic dermatitis typically appears in the first six months to five years of a child’s life. It develops before the age of one about 60% of the time.
Common triggers of eczema include:
Harsh soaps or chemicals
Scented soaps, lotions, or detergents
Extreme environmental temperatures (e.g., heat and humidity)
Illness
Pet dander
Drooling
Related: Signs and Symptoms of Heat Rash
Diagnosis
A pediatrician will usually diagnose baby eczema through a physical examination and medical history. A pediatrician is a medical doctor who specializes in the health of infants, toddlers, children, and adolescents. Your pediatrician may refer you to a dermatologist, a medical doctor who specializes in skin, nail, and hair conditions.
The healthcare provider will carefully examine the baby's skin, noting the specific characteristics and location of the rash. They will most likely ask you questions about the infant's medical and family history, when symptoms begin, how long they last, and what makes them worse or better.
Lab work is not necessary for a diagnosis. However, a provider might perform one or more of the following tests to rule out other conditions and test for allergens or triggers:
Skin prick test: The healthcare provider puts a drop of allergen on the skin and pricks it with a tiny needle. They observe the area for 15 to 20 minutes. A small itchy bump indicates an allergy or sensitivity to the substance.
Immunoglobulin E (IgE) blood test: Allergy-specific IgE blood testing can test for specific irritants like pollen, pet dander, dust mites, or foods.
Patch test: The provider applies potential allergens to the skin under special patches. Potential allergens include fragrances, metals, or preservatives. Patches are left on the skin for about 48 hours. The provider checks for redness, swelling, or itching, which could indicate an allergy.
Skin swab: The provider gently collects a sample from the rash using a cotton swab and sends it to the lab to test for bacteria or fungus.
Baby Eczema Treatment
There is no cure for baby eczema, but prevention strategies and treatments can ease symptoms. Possible medications for eczema include:
Creams or balms to reduce itching
Topical (on the skin) corticosteroid creams or ointments to reduce swelling and itching
Oral antihistamines (anti-itch medications taken by mouth)
Phototherapy (ultraviolet light)
Antibiotics or antifungal medications if there's an underlying infection
Wet wrap therapy (applying a moisturizer and covering it with wet dressings)
Prescription creams or ointments such as Eucrisa (crisaborole), Elidel (pimecrolimus), Protopic (tacrolimus), and Dupixent (dupilumab)
Always consult your pediatrician to ensure treatment is safe for your baby.
Related: How Are Allergies Treated?
How to Manage and Prevent Baby Eczema
Recognizing triggers can help you manage and prevent baby eczema flares. Prevention and management strategies include:
Moisturize the skin with a fragrance-free lotion, body butter, balms, or petroleum jelly several times a day
Avoid irritants such as harsh soaps, laundry detergents, or fabric softeners
Limit baths to no more than 10 minutes a day and use lukewarm water
Consider adding colloidal oatmeal to the bath to soothe the skin
Choose clothing with soft, breathable, and natural fabrics
Avoid tight-fitting clothing with elastic bands or rough seams
Avoid extreme heat and humidity or overly dry air
Avoid possible triggers such as pollen, pet dander, or mold
Keep the baby's nails trimmed, and consider using breathable mittens while they sleep to prevent them from scratching
Consult with a healthcare provider about allergy prevention
Related Conditions
Not all infants with eczema will develop related health conditions, but the following conditions commonly occur with baby eczema:
Allergic rhinitis: Also known as “hay fever” or seasonal allergies, allergic rhinitis involves sneezing, nasal congestion, runny nose, and itchy eyes in response to allergens such as dust mites, pollen, and pet dander. About 75% of children with moderate to severe atopic dermatitis have allergic rhinitis.
Asthma: A chronic respiratory condition that causes swelling and narrowing of the airways, leading to shortness of breath, wheezing, coughing, and chest tightness. About 50% of children with atopic dermatitis have or develop asthma.
Food allergies: Common food allergies include cow's milk, eggs, wheat, peanuts, tree nuts, and soy. About 15% of children 3-18 months who have atopic dermatitis also have at least one food allergy.
Skin infections: A compromised skin barrier can make infants more susceptible to bacterial or fungal infections, such as impetigo, where they have eczema. Impetigo is a contagious skin infection that causes itchy, fluid-filled bumps that form a honey-colored crust, caused by certain bacteria.
A Quick Review
Infants with eczema typically outgrow the condition by adolescence or early adulthood. A combination of lifestyle and medical approaches can often minimize symptoms and flares.
Treatment and prevention include avoiding exposure to environmental triggers and choosing clothing with soft, breathable fabrics. Trimming nails and using mittens helps prevent scratching and decreases the risk of further skin damage. You can teach your child self-care techniques as they get older and work with their pediatrician, and perhaps a dermatologist, to develop a care plan.
Contact a healthcare provider if your child develops signs of infection, including sore, pus-filled blisters, or crusts on the skin.
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