Moisturizer may help sooth baby's itchy eczema

My baby has problems sleeping, and I think it is because she is so rashy. I was told not to bathe her too much, but it doesn't seem to go away. Any suggestions?

Most likely your baby has eczema, or seborrheic dermatitis. We use to think that bathing these kids made them worse. If you just use water and soap, that is probably true. But if you use a moisturizer while your baby's skin is still a little wet from her bath, it will help. I personally don't have a preference for a specific moisturizer. So we now suggest that you bathe and moisturize your baby every day to "seal in" the moisture.

After ear infections and asthma, eczema is the most common condition we treat. Usually it is mild, but, especially in the very young, it can cause some problems. Sleep problems, for example, are common. Babies who have eczema have itchy skin, and cry instead of sleep.

With infants, the primary problem of eczema is dryness. I think it is hard to over-lotion a baby. The dermatologists say that the original lesion of eczema is invisible. All that happens after that is because of the rubbing of the skin.

First, it is just itchy. Then you see redness, followed by tiny bumps. The area might be a little weepy, with clear or reddish fluid. Then there is often a thickening, like a plaque. And when it resolves, it may be a little white.

There is also an allergic component to eczema. Eczema is often called atopic - meaning allergic - dermatitis. We know that children and families who have a high degree of allergy also have a lot of eczema as well.

I know many people like to split these two diagnoses (seborrheic vs. atopic dermatitis), but frankly, if they are different, they sure look and act the same.

The main treatment is to moisturize and use cortisone-based creams or ointments. Avoid allergic substances if you can.

The main allergic foods that cause problems are cow's milk, soy, eggs, wheat, peanuts and fish. Cow's milk can even be a secondary problem.

Babies of breast-feeding mothers who drink cow's milk can sometimes experience eczema.

According to Tad Johnson, a Milwaukee pediatric allergist, oatmeal can also be a trigger.

"We will test kids for allergies like this," says Johnson. "But usually the family already knows."

Now that I am doing developmental pediatrics full time, I am struck by the number of kids who have allergic skin problems. I don't know if there is a cause and effect, but it makes sense that itchy kids would be whinier, more active and just difficult because of their discomfort. Often, when kids have had low-level itchiness all their lives, they don't know that they can feel better.

Mild steroid creams, such as 1% hydrocortisone, can be bought over the counter and are very effective. There are stronger, prescription steroid creams and a few newer creams that are called "immune modulators" that have no steroids in them.

Eczema is not life-threatening, but it sure is life-altering. Most infants with eczema seem to get better each year until age 5, when the eczema becomes either very mild or goes away completely. But for many it persists into adulthood. It can clearly alter what you do in your life, what kind of clothes you wear, even where you live. Dry climates or dry winter air can be tough.

Also, skin with eczema can be prone to infection. If the skin looks particularly red and tender and if there is swelling and fever, you should get it checked out.

Eczema is something that many people just live with. But by being diligent we can greatly decrease its scope and make our children more comfortable.