Choosing a cream for baby eczema is really about personal preference. If there is no sensitivity to a chosen cream then regular application is more important than what you apply.
In many ways it is easier to outline what shouldn’t be in creams than what should; added ingredients are likely to cause reactions. Perfumes and colours are completely unnecessary and should always be avoided. Preservatives although needed in some creams, like those containing water should be kept to a minimum, additives like parabens and surfactants (detergents) are common causes of skin irritation and should be avoided.
It’s also worth mentioning Aqueous cream this was designed as an emollient cleanser and should NOT be left on the skin. It can irritate the skin of children with Eczema and make it much worse. One study of children attending one dermatology clinic showed irritant reactions to aqueous cream in over 50% of children. (Cork et al 2003) The same study showed reactions to 17% of other commonly prescribed emollients.
Eczema creams themselves can be either mineral based products or natural plant based oils and butters.
Petroleum jelly and other pure mineral based emollients are unlikely to cause a reaction even in the most sensitive of people but these creams are frequently full of preservatives and additives, they also do little to actually nourish and moisturise the skin. Creams derived from plant oils or butters still have the benefits of the living plants in them and when well chosen can have many advantages over mineral based emollients.
Moisturising is so very important that it’s great to make it an enjoyable part of you and your baby's routine. It can be a lovely time to make eye contact, smile, kiss and bond with tiny babies. Try to make it a special time for you both, older toddlers will love the attention too, even if they are a little harder to keep still!
It really is much easier to feel that your caring for and pampering your little one than medicating them.
Tips on applying creams:
- Creams should be applied at least twice daily, even when the skin looks fine, preventing flare ups is much easier than settling them back down.
- Cream should not be rubbed into the skin as this can cause redness/itching. Instead gently smooth them on in the direction the hair grows.
- Apply extra at any sign of redness or itching, and after very soon after a bath as this helps to seal in the moisture from the water.
- Keep a cream with you were ever you go so you always have some to put on at the first sign of redness, rash or itching.
- Special care should be taken to protect freshly healed skin, these areas will be especaily vulnerable to break outs for several weeks.
In wet eczema skin is so inflamed and sore it is weeping fluid or blood. When the skin is like this it requires different management to the dry or itchy stage and it can become infected. If your itchy baby develops wet eczema stop moisturising and consult your doctor quickly for appropriate treatments.
Distilled witch hazel is a traditional external treatment for wet eczema. It’s said that dabbing a cotton wool ball soaked in witch hazel can help to dry out wet eczema, help with the itching and has antibiotic properties. There are no conclusive studies to back this up but distilled witch hazel is a relatively safe product widely available so it could be worth a try on a small area. Once the weeping is controlled then it’s back to emolliating.
Eczema on babies faces.
Baby’s faces, cheeks and chin are very vulnerable to eczema breakouts. There are several reasons for this. Faces are often damp with drool meaning they are in wet contact with any irritants in clothing or toys. Messy eating means food gets onto there sensitive skin, they also instinctively chew hands and toys bringing bacteria to the skin.
Add to this a tendency too flush easily when warm, teething which can increase the blood supply to the cheeks and make their dribble more acidic, and the fact the face is always exposed to the elements and you’ll soon understand why they’re lovely faces need lots of special attention!
It’s worth keeping a pot of cream near the highchair, pop a layer on as a barrier before meals. When the meal is over clean the face thoroughly and apply more cream, covering checks, chin, hands and wrists before you get them down.
We are never far from a pot of cream, I pop some on at any signs of redness several times a day and this keeps his eczema at bay. He frequently goes bright red but we tend too avoid any soreness or itching.
Further note on safety of creams
Additives and preservatives in creams are definitely something to watch out for. What we apply to the skin is also absorbed into the body, especially so in babies. This is because baby skin is thinner and more porous than adult skin. A large skin surface area compared with body weight also means additives in creams applied all over their body can potentially reach high concentrations in the blood.
Rather worryingly the safety of some preservatives is still under question. The Health & Consumer Protection directorate-general concluded ‘The SCCP is of the opinion that, based on the available data, the safety assessment of Propyl and Butyl Paraben cannot be finalised yet’
These same chemicals have also been found in the breast tumours of women so I personally err on the side of caution.
Other very common preservatives like Phenoxyethanol can cause contact irritation. The American FDA states “Phenoxyethanol is a preservative that is primarily used in cosmetics and medications. It also can depress the central nervous system and may cause vomiting and diarrhoea”.
There are more links to additives in creams on the news and links page.
Any cream or emollient can cause skin problems in people sensitive to one or another of the ingredients, so remeber with any product it’s always important to patch test a small area first, preferably on healthy skin. When trying a cream look for redness or the child itching the area. Some creams can also sting on application which a child or baby would object too. If you are not sure about a product trust your instincts and find an alternative.
Bathing is important for eczema sufferers in many ways. It keeps the skin clean, so reducing the bacteria that can lead to infections, it washes away allergens and, if done right, it can help add moisture to the skin.
Hot water can cause the skin to dry out and it can inflame and aggravate itchy red skin, so cooler water is definitely better.
Hard water can be problematic for eczema too and there is a study underway at the moment looking into the impact of water softeners in the treatment of eczema. For most people there is little that can be done about what comes out of the bath tap, but it might be worth looking into if you’ve exhausted all other avenues. (study)
Long baths aren’t recommended for eczema skin, so spend no longer than 10 minutes. If the skin is becoming wrinkled it’s a sign the skin is drying out.
The only other hard rule is to avoid any bubble baths because the foaming agent is a detergent and can often dry and irritate sensitive skin. Shampoo can cause similar problems.
Frequency and bath additives are very much about trying different things and seeing what works best. What helps 1 baby may make another child’s symptoms worse. Many parents find daily baths too drying while others find short daily baths with moisturiser applied immediately can keep skin clean, free of allergens and irritants and well hydrated. If the skin is weeping then your doctor might recommend twice daily baths wash away exudates and help prevent infection.
There’s a huge choice of things you can add to the bath. Plant oils like a drop of sunflower oil will sit on top of the water and can be soothing and antibacterial. Other preparations, often prescription oils, will disperse leaving the water like milk.
A little sock or muslin sack of oats is traditional treatment for soothing itchy skin and one of our favourites is to give it a good squeeze under hot running water. We then use the wet squidgy oat bag as a sponge to clean face and then bum. Avoid rubbing the skin and avoid harsh detergents, soaps or washes as these will also dry out skin.
After their bath the baby or child should be wrapped in a clean towel and cuddled or patted dry. Again don’t rub the skin. Importantly their moisturiser or emollient should be applied straight away, within 3 minuets is best, but definitely within 5 minutes to help seal the water into the skin.
Itching is possibly the worst symptom of eczema, especially in little ones who can’t help but rub and scratch. It’s distracting, painful and distressing and it can seriously impact on sleep and development.
Scratching the skin worsens the problem by increasing the itch and damaging the skin further. Scratching increases the chances of skin infections and can lead to skin trauma.
Try to discourage scratching as much as possible. During the day distraction works well, but night time and sleep time is often when the problem is at its worst.
Clip fingernails as short as you can, it is often easier to cut small babies nails when there sound asleep. Try too keep the skin cooler rather than warm. If possible keep the affected skin covered.
In small babies scratch mittens or sleep suits with fold over mitts attached are useful. Specialised clothing is becoming available for babies and toddlers. ScratchSleeves or nightwear with covered mitts can really help prevent the trauma caused by scratching eczema and can often aid sleep.
Normal skin can itch too so if you see your child scratching anywhere apply some of their cream and encourage older toddlers to let you know if they have an itch so you can apply cream. Baths may help soothe irritated skin, applying cream as soon as they’re out. Clean flannels can be used as a soothing cool compress on hot itchy areas.
Keep checking back with your healthcare provider too. If the itching isn’t improving or is getting worse it may need a change of creams or medication. If the itching is very problematic Doctors will sometimes prescribe antihistamines to help at night.
There are numerous things that doctors can prescribe to help in the treatment of eczema. None of the treatments will cure eczema, but they aim to help to control the symptoms and bring the flare ups back under control as quickly and safely as possible.
Creams and bath oils are often prescribed. (see sections above).
Steroid creams have been used to treat eczema for many years and when used correctly are pretty safe. Doctors aim to use the lowest strength cream necessary and for the least amount of time needed to bring the flare up back under control. Always check with your doctor or pharmacist about how best to use the cream if you are uncertain. It’s normally a very thin smear of the cream onto the affected skin twice daily – to be used long enough to return the skin to normal. It’s important to still emolliate the skin whilst using the steroid and continue to emolliate for several weeks after treatment, as even though the skin looks better it is still very vulnerable to another flare up.
If the skin is infected your doctor may prescribe a cream with a mix of antibiotic and steroid in. Again check with them how the cream is to be used and how long for.
In severe cases systemic antibiotics or steroids may be needed in the form of medicine or injections. Ask your healthcare professional to explain why they are using the treatment and ask about any side effects if you’re concerned.
There are also some other prescription creams, Immunomodulators, which are non steroid creams that act on the immune reaction occurring in the skin during break outs of eczema. These creams shouldn’t be used in children under 2 years and although they do seem to help some people there are currently questions over long term safety of their use and the boxes carry a warning.
Antibiotics are prescribed by doctors to control infected eczema, while antihistamines are often given to help with the itching and aid sleep.
The skin is an organ and like any organ in the body it benefits from good nutrition.
Essential oils and fats can be very helpful, feeding the skin from the inside and making it less prone to breakouts. Flaxseed oil, fish oils, evening primrose oil, are commonly taken by women and a breastfeeding mum will pass benefits from these supplements in her milk to her child. Older children may benefit from appropriate supplementation and there are some fish oils now available which are for children from 6 months onwards.
Calcium is also a very important regulator in the body and is vital for skin to function properly. If your child is sensitive to dairy products it’s really important to ensure they are still getting enough calcium in their diet.
Cutting down dairy products if they are problematic may also help, as can avoiding processed food and choosing organic where possible.
Good bacteria in the body is very important. It helps in the gut with digestion and on the skin it helps balance growth of yeasts and bad bacteria. However evidence for the use of probiotics (helpful bacteria) in treating eczema is mixed. A mum can safely take probiotics and pass the benefits onto her child, and an older baby toddler can have live yogurt. Your healthcare professional may be able to advise whether they think there may be any benefit to your child from a suitable probiotic supplement.