DRY SKIN (ECZEMA) (1-12 Months)
What is happening inside my baby’s body?
Most babies have dry skin – or at least patches of it – at some point in time. When your baby is born, skin that has been bathed in water for nine months suddenly gets a rude awakening… air! The baby’s skin dries out quickly and easily. Then, each time you bathe her, the skin is air-dried a little more. Eventually parts of the skin become scaly.
Air is not the only source of dry, flaky skin. If your baby is sensitive to the perfumes in detergents, to the colours in lotions, to clothing material (such as wool), or to some component of the breast milk or formula she is drinking, then her skin will often react by drying out even more.
The medical term for dry skin is eczema or atopic dermatitils. Depending on the cause, eczema can have many forms. Classic eczema first appears on the cheeks as two perfectly round, slightly red circles. It also shows up as dry patches behind the ears and sometimes as crusting on the scalp (called cradle cap). Over the first few weeks, it moves to the wrists and ankles, and sometimes to the arms, thighs, or abdomen. Eczema can look like white flakes on the baby’s skin, colourless pinpoint bumps, or fire-engine-red patches.
When dry skin is caused by an allergy, it is called irritant dermatitis. This can be confused with eczema. The rash of irritant dermatitis typically appears wherever the irritant contacts the skin. If the irritant is detergent, then the rash will appear only where clothes washed in that detergent touch the baby’s skin. If it is a lotion or soap, then the rash will appear only where the lotion or soap is applied. If it is a food, however – including a component of formula or something a breast-feeding morn has eaten – then the rash may be around the mouth and anus, or it may spread from head to toe.
What can I do?
When something irritates the skin, remove the irritant. You should use only colour-free, perfume-free detergents, soaps, and lotions. Hypoallergenic moisturizers will help return water to the dry skin. Minimizing bath frequency cuts down on the drying effect of constant washing.
When does my doctor need to be involved?
Skin that bleeds because it is so dry needs to be treated by a doctor. If the skin breaks open, then it can become infected. If eczema continues to spread despite attempts to reduce it, then your doctor should be involved. A baby who is clearly uncomfortable because of eczema should be evaluated.
What tests need to be done, and what do the results mean?
Eczema rarely requires any sort of testing, unless it is so severe that an underlying allergy is suspected. Unfortunately allergy testing is not very accurate in children younger than two years of age. In fact, even when testing is done, the source of the eczema is not always identified. Therefore 貓口臭 it is often easiest to use trial and error, removing suspected allergens and then reintroducing them one at a time to see what happens. In the case of suspected food allergy, the trial-and-error method is called a food challenge.
The food that is thought to be the cause of the allergy can be stopped for several weeks; a rash or diarrhoea upon reintroduction usually suggests food allergy. In the case of breast-feeding, the mother must stop eating the food that is thought to be causing the problem and then, when she begins again, assess her baby for signs of allergy.
In the case of formula-feeding, you can change the type of formula (i.e., cow’s milk versus soy) to see if the skin improves. Again, if the rash returns when the original formula is reintroduced, then that type of formula is the cause.
The two main types of allergy testing are skin testing and RAST (blood) testing. Neither test is perfectly reliable in children younger than two years, but both deserve a brief mention because they may be considered for infants and young children with severe allergies.
Skin testing involves pricking a baby’s skin with tiny needles, each coated with a specific allergen – cat dander, mold, egg, etc. If the area around a specific needle prick becomes red and irritated, then the test is positive. This test works well on children older than two years, as long as someone can convince them to participate. In children younger than two years, negative results do not mean much – only a positive test proves an allergy.
For example, if the skin in the area around the cat-dander needle does not react, the child may still have an allergy to cat dander and the test can appear falsely normal.