By Heidi Moawad, MD 

 Medically reviewed by Jennifer Pollard Ruiz, MD

Baby eczema is a fairly common type of skin rash, and most babies outgrow it. The rash can be irritating or uncomfortable. Your child’s pediatrician might recommend using a skin moisturizer or making specific changes in your baby’s bath routine to help alleviate the problem. 

Dry skin can lead to baby eczema, and some babies are predisposed to the condition. Eczema, including baby eczema, tends to run in families and there is also an association with familial allergies or asthma.1

Getty Images/Tatyana Tomsickova Photography

Baby Eczema Symptoms

Your baby might develop eczema within a few weeks of birth or anytime afterward. Baby eczema typically affects the cheeks and/or the inner creases of the arms, legs, or groin, although it can appear anywhere on the skin. 

The skin may appear pink with a fine rash or as darker or purplish patches. The area may be a bit moist or dry because the skin is sensitive to both dryness and excess moisture. Rarely, you might see pimples, blisters, or an inflamed or infected appearance of the skin. 

Typically, eczema in babies isn’t associated with other symptoms, but when it’s caused by skin irritation or a reaction to food, your baby might be fussy, have trouble sleeping, spit up, or have diarrhea.

When to See a Healthcare Provider

Even if the skin issue isn’t very problematic, you should show your pediatrician the affected area when you go in for your baby’s regular medical checkup. If the rash seems to come and go, it’s a good idea to take a photo of it in case your baby’s regular appointment doesn’t coincide with a skin outbreak. 

If the skin reaction lasts for more than a few weeks, call your healthcare provider to ask what you should do about it. 

Call your healthcare provider or take your baby in for an appointment if your baby seems especially fussy, has a fever, isn’t eating as well as usual, loses weight, has blister-like or crusted skin lesions or has bleeding or inflammation in the skin around the area of eczema.

Causes

The exact causes of eczema are unknown. Babies may develop eczema due to direct skin irritation or as a result of other factors and processes inside the body. Your healthcare provider may discuss possible dietary factors and may recommend that you keep a food diary.

Research shows that babies who develop eczema due to skin sensitivity might also be prone to allergic reactions from certain foods. And there is a link between baby eczema and food allergies, which can cause symptoms besides the effects on the skin.1

Triggers

Abrasive materials, such as clothes, blankets, or towels may rub the skin, resulting in eczema. Exposure to detergents, soaps, creams, and lotions can cause it too. Extreme temperatures can also cause babies to develop eczema. Bath water should be comfortable and lukewarm, if it it's too hot and dehydrates the skin it can also trigger eczema.

Diagnosis

It’s important that you talk to your baby’s healthcare provider if the skin reaction is severe or persistent. Eczema is typically diagnosed based on its appearance. Your child’s pediatrician will need to examine your baby to determine whether the skin reaction is truly eczema or whether it could be something else—such as an infection, a vitamin deficiency, or a severe allergy. 

To help with the diagnostic process, you can try to observe if there is a pattern when it comes to your baby’s skin outbreaks. Your healthcare provider may recommend keeping a food diary and also noting the timing of any other potential exposures, such as detergents or soaps.

Diagnostic Tests

If your baby is also very ill or the rash is unusual and there is a concern that it might be caused by something besides eczema, your child’s pediatrician might order diagnostic tests to rule out other causes:

• Complete blood count (CBC): A blood test measures white blood cells (WBCs), and elevated WBCs can signal an infection in the body (not just on the skin). 

• Blood electrolyte test: For babies who have severe vomiting or diarrhea along with a skin rash, an electrolyte blood test can help diagnose dehydration. This would suggest that your baby has a severe food intolerance or allergy and not just eczema.

• Skin scraping: If your healthcare provider is concerned that your baby has a skin infection, a gentle scraping of the area may be examined in the laboratory to identify the infectious organism. Skin infections may be fungal, bacterial, or viral. 

• Allergy testing: Sometimes allergy testing can help identify a food or substance that your baby is allergic to. Allergy testing includes skin tests and blood tests. 

• Stool sample: If there is a strong concern about the intestinal microbiota (bacteria and enzymes) as the cause of eczema, a stool sample may be tested for evidence of problems with your baby’s gut microbiota.2

Treatment

Baby eczema can be treated with a few different approaches. These include:3

• Bath strategies: Lukewarm baths that last only five or 10 minutes followed by an emollient-rich moisturizer are often recommended to soothe skin. You should also be sure to gently pat dry your baby’s skin after every wash. 

• Avoid triggers: If you have noticed that your baby tends to have eczema after exposure to any particular fabric or cleanser, avoiding it can alleviate the problem. 

• Topical medications: Occasionally, a mild steroid cream or ointment may be recommended. Always follow your healthcare provider's instructions carefully since babies can be more sensitive to these treatments.

Your healthcare provider may also discuss potential dietary changes to see if it helps. For example, you might be advised to change your baby’s diet by using a different baby formula.4 And, if you breastfeed your baby, your healthcare provider may suggest that you eliminate certain foods from your diet based on your baby's allergy test. 

Although the role of probiotics in treating eczema is unknown, they are sometimes recommend. Probiotics are yeasts or bacteria that are considered healthy because they change the intestinal environment in a way that supports health.2 For example, in children who are more than a year old, whole, unsweetened yogurt may be added to their diet.

Sources

Martin PE, Eckert JK, Koplin JJ, et al. Which infants with eczema are at risk of food allergy? Results from a population-based cohort. Clin Exp Allergy. 2015;45(1):255-64. doi:10.1111/cea.12406

Wopereis H, Sim K, Shaw A, Warner JO, Knol J, Kroll JS. Intestinal microbiota in infants at high risk for allergy: Effects of prebiotics and role in eczema development. J Allergy Clin Immunol. 2018;141(4):1334-1342.e5. doi:10.1016/j.jaci.2017.05.054

American Academy of Dermatology Association. How to treat eczema in babies.

Waserman S. Doctor, can we prevent food allergy and eczema in our baby? Curr Opin Allergy Clin Immunol. 2016;16(3):265-71. doi:10.1097/ACI.0000000000000267

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.