Tender Care for Your Infant’s Eczema with Dr Dave Ong
Paediatrician at Kids Clinic @ Punggol by Singapore Medical Group
Caring and managing an eczema child can be stressful and despairing. To optimally care and manage your child’s eczema, you will need to have an optimal medical and skincare regimen. This includes skincare regimen during flares, bathing and maintenance therapy. Beyond that, your child would also require other essential skincare products like diaper cream, insect repellent, hand sanitiser, sunscreen, etc. suitable for eczema-prone skin condition.
It’s understandable that mothers will get flustered or worried when they see their baby’s irritated skin. However, eczema is a very common condition in children. Approximately 20% of children have eczema, which can range from being very mild to very severe.
In babies, it is most commonly found on the face, neck and, later on, over the flexures of elbows and knees. The skin is usually dry, irritated and red.
The most important thing for mothers to understand is the importance of ceramides. In eczema, the skin barrier is weakened because it lacks ceramide.
If you can imagine the skin barrier as a brick wall, ceramide acts like cement, keeping the skin barrier strong. However, without enough ceramide, the wall or skin barrier is weak. This allows irritants to get through and triggers inflammation and itchiness.
Eczema has a genetic link but it is a combination of genetics and environmental factors that contribute to its development.
There is no known cure for eczema. However, in terms of prevention of eczema in situations where the eczema has not developed yet, there is good evidence to show that breastfeeding can reduce the risk of eczema, and some evidence that early moisturising, from the first week of life, can help prevent eczema from developing, especially if there is a family history. There is also moderate evidence that intake of probiotics by pregnant mothers in their third trimester of pregnancy and by breastfeeding mothers can help in the prevention of eczema.
Some children also outgrow eczema. To improve the chances of outgrowing eczema, mothers should use soap-free and fragrance-free products, and moisturise their babies well after every bath with a ceramide-dominant, pH-balanced formulation such as Ceradan® Barrier Cream. This will help to reduce the frequency of flare-ups, and help improve the chance that kids will outgrow it.
The main difference is that heat rash, which usually occurs when the baby is hot, will subside once the baby cools down. However, eczema is a chronic condition and will be there for a longer period of time. On the other hand, fungal infections usually occur in warm, moist and sweaty areas including the armpits, groin, and skin folds, as well as the area between your fingers and toes.
For a proper diagnosis, you should see a doctor to be examined in order to confirm the condition and be prescribed with proper treatment. For example, a fungal infection must be treated with an anti-fungal cream.
To help strengthen the skin, it’s important to restore ceramide to the skin. This means using a moisturiser such as Ceradan® Barrier Cream. with a ceramide-dominant ratio of 3:1:1 with cholesterol and free fatty acids.
Mothers should also look for a moisturiser with a mildly-acidic pH, as the skin’s natural pH is also mildly acidic. This is part of the skin’s natural defence that also helps to keep the skin barrier healthy.
When applying this ceramide-dominant, pH-balanced moisturiser, be sure to apply it all over the baby’s skin and not just on the affected areas. This is because the lack of ceramide does not just affect one part of the skin. By applying the moisturiser from head to toe, including the face, this replenishes ceramides and strengthens the skin barrier all over, making it less likely for eczema to appear on another area.
Genetic mutations in eczema causes the skin to produce less ceramide. As ceramide is the cement which holds the skin barrier together, insufficient ceramide means that the skin barrier is unable to function properly.
Research has shown that you can help to restore or replenish ceramide in the skin by applying a ceramide-dominant moisturiser. Over time, this helps to strengthen the barrier so it can prevent loss of moisture from the skin, which contributes to dryness, and repel allergens that could irritate the skin and trigger a flare-up.
pH level is also an important factor in managing eczema. Our skin barrier has a naturally acidic pH level, while soap is alkaline. When soap is used on skin with eczema, this will raise the pH level of the skin. In addition, soap strips away the skin’s natural moisturisers. This will weaken the skin barrier further.
For these reasons, it’s important to use products that are pH-balanced and soap-free if your baby has eczema.
You can bathe babies once or twice daily, with a soap-free cleanser. Remember to moisturise well, from top to toe, with a pH-balanced, ceramide-dominant moisturiser after bathing.
It’s understandable that you may want to bathe your baby more frequently in Singapore’s warm weather, especially if your baby perspires a lot as this can also cause an eczema flare. However, you should avoid over-bathing babies as this can cause the skin to be drier as well.
If you find that your baby frequently scratches, or scratches after bathing, this may be a sign of irritation. You can try using soap-free products and a ceramide-dominant moisturiser to break the itch-scratch cycle, or bring your baby to a doctor for a proper diagnosis.
To help prevent diaper rash, regular cleaning and changing is important. Next, apply a thick layer of diaper cream. You should apply diaper cream two or three times a day, or with every change if your baby’s skin is very sensitive to diaper rash.
This will help to protect the sensitive diaper area from urine and faeces which can irritate the skin. Choose a good diaper cream that contains zinc oxide, as this acts to seal the skin surface from irritants, in a ceramide-dominant formula to help rebuild the skin barrier, such as Ceradan® Diaper Cream, which also contains an ingredient to prevent the growth of fungus and bacteria.
Food allergies are usually considered in children below 12 months of age who have extensive and difficult-to-manage eczema. If eczema is not responding well to other things such as soap-free products and moisturising, you may need to look at food allergies as a possible trigger and discuss with your paediatrician about allergy testing However, the underlying genetic defect of the skin remains and,while underlying food allergies may contribute to eczema flare-ups and may require avoidance, good skin care still remains the core of eczema management.