Infant Allergies
Steroid creams and ointments commonly prescribed for eczema can cause adrenal damage in infants and children
Infant Allergies
Steroid creams and ointments are the most commonly prescribed treatment for eczema, but can have dangerous side effects, especially for infants. Steroids are easily absorbed through the skin, and children can absorb a high percentage of the drugs because their skin is thin and they have more skin in relation to their body size. Even short courses of treatment with steroids can cause damage to the adrenal glands, which regulate the body's hormones.
Infant Allergies
Steroids work by interfering with the chemicals the body uses to signal inflammation. They turn off the inflammation response and cause tiny blood vessels called capillaries to constrict, reducing redness and swelling. Topical steroids also suppress the body's immune system and can lead to an increased susceptibility to fungal or bacterial infections of the skin.
Infant Allergies
Before using a steroid medicine, caregivers should work with a pediatrician to see if the baby's skin condition is caused by a nutritional deficiency, a food allergy, or irritation from soaps or moisturizers.
What causes baby eczema?
According to the National Institutes of Health, eczema affects up to 20% of infants and children in the United States. The rate of eczema has been rising for years, and is highest in industrialized countries. Hundreds of studies have been undertaken, linking eczema to food allergies, atopy (a triad of conditions including allergy, asthma and eczema), heredity (a child is more likely to get eczema if a parent has an atopic condition), household income (the rate of eczema seems to increase with higher income), houses that are too clean (the "hygiene hypothesis"), houses that are too dirty (dust mite allergy), urban upbringing vs. rural upbringing (kids who grow up on farms have the lowest rates of all atopic conditions)... the list goes on and on.
As eczema is a sign of an underlying condition and not an illness, the answer is probably "all of the above." Eczema can be triggered by food allergies, by contact allergies (contact with irritating substances), by nutritional deficiencies, and as a side effect of other diseases like insulin resistance and diabetes. The eczema trigger is different for each person--and may depend a lot on genetics.
Early bathing may irritate newborn skin
Bathing routines and products we take for granted may interfere with the development of healthy infant skin. Babies are born with sterile skin, which is covered by a thick, creamy substance called vernix caseosa. Vernix has antimicrobial and antifungal properties that protect the baby's skin in the womb and after birth, when the baby first comes into contact with bacteria in the outside world. World Health Organization (WHO) guidelines for newborn care specify that, to protect the baby, vernix should not be removed for at least six hours. Unfortunately, in modern societies this protective substance is immediately washed off in the hospital, leaving the baby's skin vulnerable to colonization by bacteria and fungi.
Newborn skin is very thin and loses moisture rapidly. It takes a few weeks for infant skin to develop the "acid mantle," a slightly acidic (pH about 5.5) mixture of sebum, sweat and "friendly" bacteria. (By adulthood, skin may be colonized by nearly two hundred different species of bacteria.) Ideally, over the first few weeks of life, a baby's skin is colonized by beneficial bacteria picked up from close contact with the mother and family. These bacteria perform an important function: they keep skin healthy by preventing colonization by disease-causing microorganisms. If this important step is compromised, skin can be colonized by harmful bacteria. The skin of people with eczema tends to carry a high concentration of Staphylococcus aureus, bacteria which cause skin infections, pneumonia, and even Methicillin-resistant Staphylococcus aureus (MRSA).
Excessive bathing, soap, and moisturizer use can interfere with development of healthy skin
Infant skin will naturally develop a healthy acid mantle and strong immune defenses if it's allowed to. But again, bathing routines and products we take for granted, including soaps and moisturizing lotions, can interfere with this process.
Infant skin is so delicate that even exposure to plain water disturbs it enough to dry it out. Soap accelerates this process by raising the skin's pH and removing beneficial oils, resulting in impaired skin protection for hours after bathing.
Fragrance and preservative chemicals in soaps and moisturizers irritate skin further, and can actually affect the way skin develops. What's worse, these chemicals can be absorbed through an infant's skin into the bloodstream, potentially affecting the baby's developing hormonal system.
A healthier way to care for infant skin
Babies' skin doesn't get very dirty for the first few weeks of life, so generally the less it's interfered with, the healthier it will be. Adding a half-teaspoon of lemon juice--to reduce the water's pH and add skin-friendly ascorbic acid--and a teaspoon of sunflower or safflower oil to the bathwater will keep baby clean without harming skin. If a moisturizer is needed, use a fragrance free baby oil containing sunflower or safflower oil, which are excellent moisturizers and have the added benefit of helping to prevent bacterial skin infections.
If your baby's skin does become irritated, bathing with Epsom salts or Dead Sea salts is a safe and clinically proven way to soothe irritated skin. (Epsom salts are not salt at all, but magnesium sulfate, a natural mineral effective for soothing inflamed skin. Dead Sea salts are evaporated mineral salts from the Dead Sea in Israel.)
Some magnesium in an Epsom salts bath is absorbed through the skin and is a safe way to supplement this important mineral, while Dead Sea salts provide a whole range of vitamins and minerals essential for healthy skin, including magnesium, zinc, potassium, copper, and B vitamins. A teaspoon of bath salts is plenty for an infant bath.
For older kids and for gentle cleansing when soap is required, try a natural bar soap or highly diluted castile soap, like Dr. Bronner's.
Nutrition affects infant skin
The nutritional value of the food we eat has changed dramatically over the past several decades. "Factory farming," where fields are sown with the same vegetables year after year, fertilized with petroleum by-products and sprayed heavily with herbicides and insecticides, has reduced levels of key vitamins and minerals in vegetables. Meat and dairy animals are raised on huge feedlots, fed an unnatural diet of grain and animal by-products, and heavily dosed with antibiotics to keep them alive long enough to slaughter.
Eczema is strongly connected with nutrient deficiency, so it's not surprising that a decline in the nutritional value of food would coincide with an increase in rates of eczema.
Baby eczema may be a sign of zinc or magnesium deficiency
Deficiencies of zinc or magnesium are fairly common and cause symptoms which are indistinguishable from other types of eczema. A deficiency of vitamin B6 may result in seborrheic dermatitis, or cradle cap.
When a breast-fed baby develops eczema, the mother's diet is often suspected as the cause. However, the eczema may have nothing to do with food allergy. Breast milk is often low in zinc, and a sign of zinc deficiency is dry, irritated skin. Recent studies suggest that zinc deficiency may be much more common than previously suspected. Low levels of magnesium may also cause eczema-like symptoms by raising the level of histamine in the blood and making the body more sensitive to allergens.
A simple blood test can identify a zinc or magnesium deficiency, and supplementing with the missing mineral may solve the problem. A special kind of zinc can also be applied as a topical cream for absorption through the skin. Caregivers should talk to their pediatrician about correct dosing before giving a baby a vitamin supplement.
Formula-fed babies may also be deficient in vitamins or in essential fatty acids (EFAs) - fats which are essential to healthy development of the brain, nervous system and skin. Some babies may not be able to utilize the vitamins and fats in baby formula, or the formula itself may not provide enough of them. A doctor or knowledgeable nutritionist can help caregivers choose a more appropriate formula or supplement with the necessary vitamins and essential fatty acids-especially zinc, magnesium, and docosahexaenoic acid (DHA), a type of EFA.
Food allergies and eczema
About 30% of infants and children with eczema test do positive for food allergies. A baby or child has a much greater chance of developing food allergies if either of the parents have allergies themselves. The most common allergens include cow's milk, soy, egg, wheat, peanuts and shellfish. In breastfed babies, allergens from foods may pass directly to the child through breast milk. Avoiding these foods while breastfeeding may keep the child from developing eczema or other allergic reactions. The La Leche League website has an excellent page on allergies and breastfeeding.
In formula-fed babies, changing the formula may eliminate the problem. Special, easy-to-digest hydrolyzed formulas (formulas where the proteins are partially broken down) are often recommended for formula-fed babies with food allergies. Adding probiotics or prebiotics - beneficial bacteria that live in the gut and help digest food - to infant diets helps to reduce or prevent both food allergies and other illnesses and has been shown to help relieve eczema, too.
Breastfeeding longer, introducing solid foods late (after 6 months), introducing new foods one at a time, and waiting to introduce allergenic foods until after the baby is about a year old help reduce the risk of allergic reactions. Most babies outgrow early allergies to milk and eggs, although peanut allergy is more likely to persist to adulthood. However, children with food allergies are more likely to develop asthma or other atopic diseases when they grow older. Caregivers should talk to their pediatrician if they suspect a food allergy. A food elimination diet should only be utilized under a doctor's supervision, to limit the risk of nutrient deficiency.
Treating the root cause of eczema, rather than the symptoms, will start your baby on the road to a lifetime of healthy skin.
