What causes facial eczema in babies?

Why does eczema develop?

Atopic dermatitis, the most common type of eczema, involves the skin barrier and immune system. The barrier is the outer protection that helps skin hold water and keep irritants out. In eczema, inherited changes and inflammation weaken that protection. Skin loses water more easily, and irritants can enter more readily. Eczema often runs in families with eczema, asthma or hay fever, but babies without that family history can develop it too. Some flares happen without an obvious trigger. Eczema is not contagious.13

Why does it appear on the cheeks?

The cheeks, forehead and scalp are common eczema sites in babies. Skin often feels dry, rough and itchy. On lighter skin, patches commonly look red; on darker skin, they can look dark brown, purple or gray, with rough bumps rather than obvious redness. Babies often rub their faces against blankets or other objects to relieve itching. That rubbing can leave skin raw or cause bumps to ooze and crust. Discomfort can also disrupt sleep.4

What can make facial eczema worse?

Common aggravators include soap, harsh detergents, perfumed products, rough fabrics, cold dry air, overheating and frequent washing with very hot water. An irritant reaction is not the same as an allergy. Dribble and food touching the skin can also cause dermatitis around the mouth and chin, so the location of a rash can offer a clue about contact irritation.15

Not every facial rash is atopic eczema. Contact dermatitis develops when something touching the skin irritates it or causes an allergic reaction. Even a product used for years can become a problem. Seborrhoeic dermatitis is another possible cause of a facial rash, with oily looking or dry, scaly skin. Buying more skin care is not the same as identifying what touches the face, even if the shopping basket looks impressively prepared for parenthood.6

Could food allergy be responsible?

Food allergy can worsen eczema, but facial eczema alone does not identify a food allergy. Other reaction signs include swollen lips or face, wheezing, vomiting and an itchy rash. Reactions often happen within minutes, although some take longer. Do not experiment by cutting out milk or another major food: babies can miss essential nutrients. Discuss suspected reactions with your baby's doctor. If your baby has eczema, ask for advice before introducing foods that commonly cause allergies. Breastfeeding parents do not need to avoid these foods unless they themselves are allergic.7

What should you do now?

Daily skin care helps control dryness and can reduce the need for medicines. A care plan can use creams or ointments, which sounds less grand than calling the nursery shelf a skincare collection.2

1. 1Wash gently with a gentle cleanser rather than regular soap. Keep baths short and cooler rather than long and hot.
2. 2Avoid scrubbing or rubbing hard when drying. Apply moisturizer while the skin is still damp to help trap water.
3. 3Continue moisturizing two to three times daily. Choose products without scents, dyes or alcohol, and avoid products that clearly worsen symptoms.
4. 4If medicine is needed, follow your baby's clinician's directions for the exact product and duration. Do not use hydrocortisone longer than directed.

When does your baby need medical care?

Contact a clinician if home care does not help, the rash worsens, or your baby has pain or fever. Yellow or golden crusts can signal a bacterial infection. Blisters or bumps with fever can indicate a serious infection called eczema herpeticum and need immediate medical care. Breathing problems or a swollen tongue or throat after food are also a medical emergency.247

Eczema can come and go rather than clear permanently after one flare. Many children improve as they grow, but there is no reliable way to predict when an individual baby's eczema will settle.45