| BABIES WHO HAVE ECZEMA |
| There are different skin disorders,
some of which can start very early on in life, such as cradle
cap. |
| Cradle Cap |
| This thick scurfy scalp
can appear soon after birth or when the baby is a few months
old. It can develop suddenly. The scalp becomes coated with
greasy yellow scales that stick to the head giving a crusty
appearance. This scaliness can affect other parts of the baby’s
face and head including the forehead, temples, eyebrows, behind
the ears and in the neck folds. The skin underneath the scales
may look sore, but it is not a condition that causes discomfort
or itching and baby will feed and sleep as normal. |
| During the first few weeks
the condition is usually due to the continuing secretion of
the greasy coating seen on babies straight after birth. When
this dries up the scalp clears. |
| If the cradle cap develops
later on it may be due to infantile seborrhoeic eczema and
is usually seen on other parts of the body such as the groin
and under the arms. Psoriasis can also look like cradle cap
in infancy as it also causes a scurfy scalp. |
| If the cradle cap doesn’t
seem to be clearing up consult your Doctor. If your baby has
accompanying symptoms such as diarrhoea, vomiting or fever,
or is fretful, listless and not feeding properly, see your
Doctor straight away. These symptoms may be an indication
of psoriasis or seborrhoeic eczema which needs a different
form of treatment. Or, of course, they can be symptoms of
other illnesses. |
| Treatment |
| If your baby is diagnosed
as having cradle cap, the first thing to know is that you
don’t actually have to treat it. It is not doing the
baby any harm and will go away of its own accord. But if you
find it unsightly you can try the following to speed things
up: |
- Shampoo gently to remove the crust and excess scales.
Wash the scalp daily, using a mild baby shampoo and tepid
water, but make sure you rub very gently.
|
- Massage the baby’s scalp using slightly warmed olive
oil. Again, make sure you work the oil into the scalp very
gently. Leave the oil on for an hour or two and then wash
it off with a mild shampoo.
|
| Alternatively, you could
massage emulsifying ointment or aqueous cream into the scalp,
leave it on for a few hours and wash off with warm water.
These creams mix well with water so you don’t need to
use shampoo as you do with olive oil. If the ointment seems
too solid, stand the jar in a bowl of warm water to soften
it a little. Be careful not to apply too much pressure as
you massage, paying extra attention to the fontanels (the
soft part at the centre of the baby’s head). Do this
daily until the scalp clears. |
| Infantile Seborrhoeic Eczema |
| This condition can appear
quite suddenly between two weeks to six months after birth.
You may notice it first on the nappy area, but it seems to
quickly gather momentum and you may find that it has quickly
spread and is on the scalp, face (often including the forehead,
temples, eyebrows and behind the ears), neck, armpits, nappy
area and trunk. The good news is that it improves almost as
quickly as it spreads! Also, it looks worse than it is. It
is not a very itchy condition, nor is it sore. The baby feels
well and will eat, sleep and play normally. |
| Seborrhoeic eczema on the
scalp appears in the form of large, yellow, greasy scales
which stick to the scalp making it look crusted. This is why
it is often mistaken for cradle cap. |
| What causes the condition
is unknown. Family history of skin conditions does not seem
to play a part; nor does it mean that it is going to turn
into atopic eczema or another skin condition. The baby may
go on to get atopic eczema but it is not related. One in ten
children under the age of five have atopic eczema: some of
these will have had seborrhoeic eczema as well. |
| A certain type of yeast
has been found on infants who have seborrhoeic eczema and
this may be the cause of the rash. But please note that this
is not caused by yeasts in the baby’s diet. |
| In
its mild form, seborrhoeic eczema is unlikely to become infected.
As long as the skin is unbroken it should not cause any problems
and is easy to treat. You would be right in suspecting a bacterial
infection if the baby’s skin feels hot, smells odd,
or is weepy. This is most likely to occur in the folds of
skin. You need to see your doctor if this happens. Also the
skin may become raw and sore, particularly in the nappy area,
and become infected by a yeast called Candida which lives
on the skin in that part of the body. This can lead to thrush.
There are creams available to treat severe cases of this condition. |
| Treatment |
- Bathe the baby daily but don’t use soap or bubble
bath as both these dry the skin. You can use a soap substitute
like aqueous cream, or emulsifying ointment which you
can obtain from the chemist. Gently rub the cream or ointment
on to the damp skin and then wash it off in the bath.
You can also get special bath oils to help moisturize
the skin. Please be extra careful as the baby will be
very slippery.
|
- Moisturize the baby’s skin all over with an aqueous
or moisturizing cream. Do this several times a day to
keep the skin soft and supple. If the skin is sore in
places, your Doctor may prescribe a weak steroid cream
– with 1% (or less) hydrocortisone. Use this sparingly
and only in the areas where the skin is sore. If the skin
is infected the Doctor may prescribe a cream that contains
an antibiotic as well as a mild steroid. In the case of
thrush the special cream prescribed may be a formula containing
an anti-yeast with the steroid. All these creams should
only be applied, in small quantities, to the areas infected.
|
- If it is crusty or scaly, treat the scalp in the same
way as cradle cap described above. Again, if the scalp
is very sore, your Doctor may prescribe a mild steroid
cream to use sparingly until the condition improves.
|
- Change nappies frequently and keep the nappy area clean
and dry. This should prevent the skin becoming sore and
infected. You may need to change the nappy every hour
certainly change them as soon as they become wet or soiled.
If the nappy is wet or soiled, wash the area in a little
warm water with oil or cream added. At every nappy change
apply an aqueous cream or zinc and castor oil cream to
keep the skin soft and protected. Try not to use plastic
pants over nappies as they can create hot and humid conditions
which help the bacteria breed and can make the eczema
worse.
|
These treatments are time
consuming and can be very tiring, but if the baby’s
skin is sore and infected this extra attention are necessary
to help the healing process. |
| Atopic Eczema |
| This condition can develop
at any time. It is far more distressing than cradle cap or
seborrhoeic eczema because it is itchy and sore. It can appear
anywhere on the body, often starting on the face when the
baby is three or four months old. The cheeks can become very
red and sore, and it then migrates to other parts of the body. |
| The eczema is usually particularly
apparent in the body folds; in the backs of the knees and
creases of the elbows, on the wrists, ankles, neck, ears and
nappy area. It also appears on the eyelids and scalp. One
early tell-tale spot is in the place where the ear lobes join
the face. If this spot looks at all sensitive, suspect eczema
and be careful when you dress and undress the baby. It is
very easy to split that part of the skin when you are removing
clothing. |
| Atopic eczema is a dry,
scaly, inflamed skin condition. When it is hot the skin dries
and cracks open. It is important not to let the baby get too
hot or cold. Make sure the bath water is tepid. A baby with
eczema does not have the same temperature control as babies
without this condition. |
| The severity of the eczema
can be very different from baby to baby. One will just have
a mild rash say, on the elbows and knees with sensitive or
cracking earlobes while another will be covered with an itchy,
red, sore, and weepy skin and obviously in constant discomfort.
|
| How do you tell if your
baby has eczema? Here are some guidelines but please note
that the following is just an indication and you really do
need to get a diagnosis from your Doctor: |
| Indications of Atopic Eczema in Babies |
- Itchiness is a strong factor but babies tend to rub more
than scratch. Look out for redness in the forehead and the
wrists as well as cracking and breaking of the skin.
|
- A dry skin is very indicative of atopic eczema.
|
- If the eczema is infected it will be weeping and oozing
and there may be yellow/brown crusting.
|
| Treatment |
| You cannot stop a baby rubbing
or scratching and you should never make any attempt to tie
a baby’s hands or restrict movements as this would add
to the baby’s stress and could make the eczema worse.
But you can lessen the effects of the rubbing or scratching
by: |
- Keeping the baby’s nails short
|
| |
- Using cot bumpers can ease the effects of rubbing.
|
| Minimizing the itch factor
is always a question of keeping the skin moisturized and as
free as possible from secondary infection by means of special
baths. |
| Bathing Babies |
| Bath babies daily in a bath
of tepid water to which a special oil or emollient has been
added. Emollients are ointments or creams which are mixtures
of water, waxes, fats and oils in varying proportions and
they can come as ointments which are better on a very dry
skin, so you may want to use that at night, with cream for
the daytime. |
| Emulsifying ointments and
creams are not as easy to disperse throughout the bath as
oil, but you can add a tablespoonful of emulsifying ointment
to boiling water and mix these together first, in a separate
container, before adding them to the bath. |
| If the baby is fretful during
bath times, add lots of toys to the bath as playing with them
will help extend the bath and hence the treatment time. But
remember never to leave a baby unattended in the bath, and
don’t forget that he/she will be very slippery when
you take him/her out. |
- Never use soap or bubble bath which dries the skin.
|
| Emollients are safe to use
and rarely cause allergic reactions, but products containing
lanolin, which is a fat derived from sheep’s wool, can
occasionally have this effect. It really is a question of
trial and error to find out which products suit your baby
best. |
| Moisturizing |
| Moisturizing the skin is
very important as it keeps it supple and less likely to crack.
You will need to do this at least twice a day, using emollient
cream. After the bath is a good time as the skin is moist.
Pat the skin with a soft towel leaving it slightly damp. First
apply any steroid creams or ointments you have been prescribed,
allow time for the medication to be absorbed and then gently
apply the emollients. |
| Always wash your hands before
applying creams or ointments and make sure that containers
are closed tightly straight after use. Eczematous skin can
become infected if the contents of the container are contaminated.
If you have more than one eczematous person in the family
make sure each has his or her own supply of emollients to
avoid cross-infection. |
| Apply cream thinly and smooth
it in. If the preparation is thick, apply it in small dots
on the parts of the body affected, working from the head to
the toes, so the cream will have melted and become more manageable
by the time you come to gently smooth it in. |
| In addition to knowing the
names and purposes of the different creams you will be using,
it is useful to record how much cream you are using. It usually
comes in the following weights: 15 gm, 30 gm, 50 gm or 100
gm. Note how many tubes or tubs you use and compare it with
the guide below. |
| Minimum amount of emollient cream (grams) required
for twice-daily application for one week. |
| Age |
Whole
Body |
Trunk |
Both
Arms
& Legs |
| 6
Months |
35 |
15 |
20 |
| 4
Years |
55 |
20 |
25 |
|
| Treating With Topical Steroids |
| The word ‘topical’
means something that you apply at the site of the problem.
Steroids are substances produced by the body to help the healing
process. Steroids produced for medicinal purposes aim to have
the same effect. They can be very helpful in treating all
manner of illnesses, but taken orally (by mouth) they can
have serious side effects, one of which is to restrict growth.
|
| This is very unlikely to
happen with steroid formulations applied to the skin, but
having said that, bear in mind that a baby’s skin is
very permeable. This is why steroid creams and ointments prescribed
for babies are usually of a very weak formulation (1% hydrocortisone)
unless there is a special reason for the extra strength –
in which case the treatment is likely to be only for a short
time. Also, strong doses of steroids used over a long length
of time can produce thinning, stretch marks and reddening
of the skin. |
| However, topical steroids
can reduce itchiness and speed up healing so they are extremely
useful in controlling a flare-up of the condition. Used with
caution, they can often spare both the baby and parents undue
suffering. If the eczema becomes infected you must see your
Doctor straight away. Infected eczema can be tricky to treat
on anybody, but a baby obviously has to be very closely monitored. |
| |
Information contained in this
article was obtained from Exchange Journal
published by the National Eczema Society |
This Information Sheet is
one of a series provided as a service by the Eczema Association
of Australasia Inc to give up-to date, practical help on certain
types
of eczema or a particular aspect of its treatment.
These sheets are part of our membership package. |
It is not the policy of the
Eczema Association of Australasia Inc to recommend
or endorse any product or treatment. It is part of the role
of the Association to
provide information on a wide range of products and treatments
to keep those
involved with eczema as fully informed as possible as to all
options available. |
| |
Printed with the permission of the Eczema Association
of Australasia Inc
For more information about this article please contact:
ECZEMA ASSOCIATION OF AUSTRALASIA INC
PO Box 1784 DC CLEVELAND QLD 4163
P: 1300 300 182 or 07 3206 3633
F: 07 3206 3666
E: help@eczema.org.au
www.eczema.org.au |
 |
