What is Dermatitis?Dermatitis is a generic term for inflammatory (eczematous) skin diseases. It is an itchy, often inflammatory rash. Atopic dermatitis is common in babies but has a good overall prognosis and usually disappears until school age. In case of allergic or familial stress for allergies the rash could persist longer. Occasionally there is a change of symptoms at school age, it can inhalative allergies (the triggering substances are brought to the ambient air) and also asthma. Dermatitis is also called atopic dermatitis or contemporary atopic dermatitis. Atopic means that your child has inherited the predisposition to rashes, asthma and hay fever. The end result, however, remains the same: dry, itchy, red and chapped skin, which sometimes secretes fluid and can also bleed. The most affected are the hands, face, neck, elbows and knees (BAD 2013).
If you have atopic dermatitis, the skin's protective layer will not work as it should and it will dry out. The skin is thus also more susceptible to inflammation and allergens (substances that can cause allergies), which makes the condition worse.
What causes dermatitis?It's still not clear how dermatitis develops, but it could have genetic causes (BAD 2013, Irvine et al 2011). Allergies such as dermatitis, asthma and hay fever have increased in recent decades and seem to have settled in recent years.
You will experience that there are outbreaks. It may be that your baby's skin is always a little dry and itchy, but then worsens and inflames when it breaks out. This always happens when your child's immune system overreacts to a substance that is allergic to it (allergen). Then your child needs more intensive care.
Mental stress can also lead to a worsening of the skin situation (hence the former name of atopic dermatitis).
Such outbreaks can also be caused by skin irritations caused by chemicals: for example, cleansers in bath products, shampoos, washing powders and fabric softeners. You can try changing the detergent to see if that helps your baby.
Eczema can be particularly harsh for babies as they instinctively scratch themselves, causing dermatitis. In some cases it also disturbs the baby's sleep and undermines his self-confidence (NICE 2013).
How can I treat my baby's eczema?The treatment depends on the severity of the disease. If your baby has mild dermatitis with a few reddish-itchy areas, a softening lotion, ointment or cream may be sufficient. Your doctor may occasionally combine this with the administration of a weak steroid ointment (NICE 2013).
It's essential to keep your baby's skin moisturized to prevent breakouts. Even if no eczema is currently seen, children with dermatitis should be given generous amounts of moisturizing lotion several times a day, as this will prevent the skin from overdrying (CKS n. D, NICE 2007).
There is a wide range of these remedies such as creams, ointments, lotions and bath products. Try different to find out what works best for your child.
You probably need large amounts of it regularly. Once you know which one works best, your doctor should issue you with the prescription several times. Avoid a water-based cream. It may contain detergents that may irritate your baby's skin (BAD 2013, MRHA 2013, NICE 2011, Tsang et al 2011).
Can steroid use harm my baby?Doctors often recommend the additional and temporary use of a steroid cream or ointment. If used properly, they are harmless (BAD 2013). The side effect is that the skin becomes thinner when used over a very long period of time. But there is no evidence that this effect persists.
The strength of the steroid ointment should match the strength of the eczema and it should only be used under medical supervision. Your doctor will also show you how much you should apply to your baby's skin.
The steroid ointment or cream should only be applied to affected skin areas, preferably not more than once a day and only steroids in groups 1 and 2. (BAD 2013, NICE 2013) Remember to always use plenty of moisturizer You can apply as much as your baby needs.
What treatments are still available?When eczema is particularly itchy and disturbs your baby's sleep, oral antihistamines are sometimes prescribed. This is not part of the standard treatment. Antihistamines that are suitable for children often cause drowsiness, so they are best used at night. You should always talk to a doctor before using antihistamines (NICE 2007).
If your child's eczema is more severe, it may also require stronger steroid ointments (BAD 2013). If the eczema does not respond to treatment, your baby should be referred to a specialist dermatologist for further treatment (NICE 2007).
Another treatment for severe cases of dermatitis is dry bandages and wet compresses. Envelopes are soaked in moisturizer or steroid ointment and wrapped in dry bandages (NICE 2007). This method helps to provide the skin in depth with ointment or cream.
What happens when the eczema burns?Dermatitis can worsen with skin inflammation, often caused by scratching, that breaks the skin. If your baby's dermatitis becomes inflamed, it can bleed, become crusty or wet. Now the use of oral antibiotics will be necessary to stop the infection. If only a small area of the skin is inflamed, it may also be prescribed an antibiotic ointment. However, larger areas require the use of antibiotics (NICE 2007, 2011).
Can I do something to prevent outbreaks of dermatitis?
- Exclusive breastfeeding for at least four months can help protect your baby from dermatitis and other allergies. (Greer et al 2008)
- Some children who develop dermatitis may be allergic to cow's milk, but be sure to talk to a doctor before you delete cow's milk (or cow's milk substitute) from your baby's diet. If your baby is being fed infant formula, your doctor may recommend a hydrolyzed protein meal trial (NICE 2007). Soy-based foods and goat's milk are not recommended in this case.
- There is no valid evidence that it protects the baby from dermatitis if the mother omits certain foods during pregnancy or breastfeeding (Kramer and Kakuma 2006). But it's worth talking to your doctor if you feel that some of the foods you eat cause your child to react. Do not change your diet without consulting your doctor.
- There is some evidence that taking probiotic bacteria (either as a dietary supplement or foods such as yoghurt) during pregnancy may reduce the chance of your child getting dermatitis (Kallimaki et al 2001, Lee et al 2008, Osborn and sense 2008). Further research is necessary to make a statement.
Is there anything else I can help my child with?You can do the following things yourself:
- Keep a journal to find out what causes your child a boost. Discuss the results with your doctor.
- Some experts think that exposure to certain foods could aggravate dermatitis. So it might be an option to omit these foods. But do not change your baby's diet drastically without first talking to your doctor.
- Another track that is being followed by doctors is house dust mites.That these can cause certain cases of dermatitis, but has not been sufficiently proven. Since it is impossible to get rid of house dust mites anyway, many doctors think it's better to focus on the treatment of eczema (BAD 2013, CKS n. D).
- Because woolen and synthetic clothing can be very warm, it can aggravate the rashes. Try cotton baby clothes (BAD 2013).
- Make light bedding and clothes in multiple layers so you can easily regulate your baby's temperature.
- Cut your baby's fingernails short so that it irritates the skin as little as possible when scratched.