Our Oh-So-Sensitive Baby Skin – Is it Eczema?

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Smooth like a baby’s skin. We’ve all heard this phase. We’ve also heard the pitch from brands targeting parents, that their products are suitable for the baby’s sensitive skin. More often than not, our babies’ skin is silky soft, but it is also ultra-sensitive. In many cases, our babies would get some sort of bumps or rashes either localized or full-bodied. I’ve been one of those moms, asking in mom groups and searching high-and-low for answers to what those skin rashes are, and why they are occurring. It very quickly became evident to us that our LO’s skin rashes were a result of eczema. We were also aware of eczema as one of our LO’s grandparents has life-long eczema. Fortunately, not every baby who has skin rashes or bumps has eczema. We turned to our friend, renowned allergist and immunologist Dr. Sanjeev Jain from Columbia Allergy, to clear up some of the muddled information surrounding baby skin conditions.

What is the difference between diaper rash, fungal infection, heat rash, psoriasis, and eczema?

Psoriasis and eczema are immune-mediated chronic skin conditions in which the normal skin barrier is disrupted. Fungal infections, heat rashes, and diaper rash are all acute conditions, meaning they occur and resolve over a short period of time.
Psoriasis is a chronic skin condition that is characterized by silvery plaques with a red base. The onset of psoriasis is typically less than 20 years of age. Psoriasis may appear on the scalp and can often be mistaken for dandruff. Psoriasis patches may wax and wane, but will always reoccur without treatment. If you suspect a child has psoriasis, we recommend consulting with your provider to confirm a diagnosis and create a treatment plan.
Eczema is the collective term for a group of skin conditions that can cause rough patches of skin that look leathery or scaly and can be dry, itchy, and red. Eczema is not contagious, but the exact cause of eczema is unknown. Researchers have found that your genetics can make you more likely to develop eczema, and you may be at a higher risk if you also have asthma or allergies. There are several different types of eczema, with the most common being atopic dermatitis. Atopic dermatitis is an immunologic response to an irritant or allergen. The rash can develop at any age, it may come and go, and you may not know what triggers your flare-ups. Eczema rashes develop when an irritant triggers your immune system. Some common triggers include harsh soaps and laundry detergents, cleaning solvents, foods such as nuts and soy, medications, stress, dust mites, and wool and synthetic fabrics.
Diaper rashes can be caused by irritation from the diaper itself or from a fungal infection. Diaper dermatitis is non-infectious and can appear as a red that is located where the diaper was in contact with the skin. This type of rash will typically improve with more frequent diaper changes, exposing the skin to air, and using a diaper barrier cream. Fungal diaper rashes occur when a fungus begins to grow in the damp, moist environment of the diaper region. These rashes are typically “splotchy” and beefy-red in appearance. Fungal rashes may extend past the area of the diaper and will only resolve with the use of a topical antifungal medication.

Heat rash often occurs after a child is exposed to increased temperatures and sweating from situations like hot days or exercise. This rash will typically occur in areas with folds like the neck, groin, armpits, behind the knees, and in the elbow creases. The rash will typically occur as pinpoint vesicles with a red base. This rash will typically improve after cleaning the skin and with cooler temperatures, although it can become infected and require additional treatment to clear up.

How does diet affect baby skin? Which foods or environmental particles are common eczema triggers?

Diet can noticeably affect a baby’s skin if they suffer from food allergies or eczema. Babies who develop food allergies may experience hives during an acute reaction. Additionally, babies with eczema may experience a worsening in symptoms when exposed to a food that their body has identified to be an allergen. If a baby ingests food that their immune system has identified as foreign, their immune system will respond by releasing inflammatory mediators that can cause itching, redness, and irritation of the skin. Breastfed babies with food allergies and eczema can potentially have symptoms if the breastfeeding mother ingests the foods that the baby has difficulty with.

Common eczema triggers include dust mites, grasses, tree pollens, harsh soaps and detergents, scented beauty products, products that dry out the skin like hand sanitizer, and foods like milk and egg.

Why is eczema a life-long condition in some and others quickly outgrow it?

Eczema is an immune-mediated condition that many children are diagnosed with. Within the first few years of life, the immune system undergoes large changes. As a result, some children may be able to outgrow eczema as their immune system matures and self-regulates. However, those whose immune systems are not able to correct the abnormalities will continue to experience eczema symptoms on and off especially after being exposed to triggers like stress, illness, and allergens.

Can perfume or makeup trigger or worsen eczema?

Patients with eczema have an immunologic disorder that results in a disrupted skin barrier, so the use of any topical products like makeup or exposure to chemicals like perfume scents can cause a worsening in symptoms. When these foreign substances come in contact with the skin, the immune system may detect an invader and respond by creating increased inflammation leading to more itching and dry skin. It is recommended that patients with eczema stick to fragrance-free products and avoid makeups that contain ingredients that can be irritating to the skin.

How do I achieve the balance of helping my baby strengthen their immune system and preventing eczema triggers?

As the immune system is developing, we want to intentionally introduce different organisms to the immune system as this is a crucial step in developing a baby’s immune system. These organisms include pollens, bacteria, viruses, foods, and more. However, after a known allergen or eczema trigger has been identified, it is best to avoid the trigger and not stress the immune system. Babies who have food triggers for their eczema may benefit from food avoidance or allergy desensitization treatments like sublingual immunotherapy (SLIT). Babies who have environmental triggers for their eczema can benefit from precautions taken within the home to reduce exposure to allergens.  Hypoallergenic bedding and pillow covers, washing bedding on hot, using an air purifier and vacuum with a HEPA filter, and keeping windows closed during periods with high pollen counts can help reduce exposure to allergens found within the home such as dust mites, pet dander, and pollens. Keeping windows closed on days with high pollen counts can also help reduce exposure.




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