Atopic dermatitis (AD) is a chronic inflammatory skin condition. It is very common in infants, sometimes appearing before 6 months. It typically results in patches of dry, itchy, and inflamed skin. In babies, AD most commonly appears on the face and cheeks.
AD is a type of eczema. This refers to a group of conditions that result in irritated, inflamed, and often itchy skin. Eczema is a prevalent skin condition in infants, with AD being the type that most commonly affects infants and children.
There is currently no cure for AD in infants. However, using treatments and home remedies can help control symptoms and help relieve pain and discomfort.
In this article, we will discuss the prevalence, symptoms, and treatments for AD in infants.
AD is very common in children. A 2014 report suggests that AD has a prevalence of at least 10% in the pediatric population of the United States. It also states that AD primarily affects children, with onset occurring before the ages of 1 and 5 years in 65% and 85% of children with AD, respectively.
A 2021 article also notes that AD occurs in approximately 10–30% of children, with early onset AD being the most common type. This refers to AD that occurs before the age of 2, which many may call pediatric eczema.
Roughly 60% of AD in young children starts before they are 1 year old. A 2018 article adds that this number increases to 85% of all cases by age 5. So, the large majority of cases occur in babies and very young children.
While AD is common in infancy and may persist throughout childhood, many cases might resolve naturally by the age of 12. It is also possible to get AD later in life, such as after puberty or as an adult.
AD can develop anywhere on the skin at any age. However, it is more likely to appear in specific areas during certain stages of growth. For example, most infants may experience AD on their face and cheeks, scalp, and eyelids. This is because these areas are more likely to become dry and may be prone to rubbing.
As infants learn to crawl, they may also experience symptoms on their knees and elbows, which may rub as they crawl or are within reach to scratch.
Other commonly affected areas may include:
- inside the elbows
- behind the knees
- wrists
- ankles
- hands
AD is more likely to occur in dry areas, so it is rare for it to develop in the diaper area as the skin is typically too moist. If an infant experiences a diaper rash, it is more likely to result from irritant contact dermatitis.
The symptoms of AD in a baby can vary. The characteristic sign is irritated and itchy skin in areas such as the face. The skin will often feel dry, raw, and scaly.
Additionally, as the skin may cause discomfort, caregivers may notice the infant becoming fussy and having trouble sleeping. They may rub against objects to try and relieve the itchiness. It is also possible that infants may develop skin infections due to excessive rubbing. Their skin may appear to bubble up and weep a clear fluid.
The exact cause of AD is unclear. However, evidence suggests it involves an interaction between genetic, immune, and environmental factors and how this can affect the dryness of the skin.
Genes seem to play a role in the condition. A 2021 article notes that having one parent with AD gives an infant a 50% chance of having it, too. If both parents have a history of AD, that chance increases to 80%.
The immune system develops early in life, so an overreaction of the immune system may relate to the high occurrence of AD in infancy. The environment may also play a role, as exposure to certain irritants, allergens, or environmental factors may trigger eczema.
There may be a link between other allergies and AD. A 2020 review notes the relationship between allergic conditions, which many experts refer to as the atopic march. It usually begins with AD in infancy and may progress into allergic asthma and allergic rhinitis in childhood.
To properly diagnose AD in infants, doctors will perform a physical examination of the skin to identify any affected patches. They will ask about the medical history of the child's parents, including a history of allergies or eczema.
They may also ask questions about the severity of symptoms, such as itchiness in the skin, as well as whether symptoms get worse at certain times. This might include while sleeping, after bathing, or when coming into contact with potential allergens.
In a few cases, doctors may recommend using allergy tests to check for allergens. This may include a skin prick test or allergy patch tests to help identify potential triggers. Allergy skin tests are not always necessary and may be less accurate in babies, but they might help identify allergens and triggers if the symptoms do not respond to standard treatments.
While there is currently no cure, treatments can help to control the symptoms of eczema. For an infant, this will typically include avoiding triggers and scratching, and using natural fibers and gentle creams on their skin.
In some cases, doctors may recommend medical treatments to help ease symptoms and underlying inflammation. This may include the use of emollient creams or over-the-counter products that relieve itching and inflammation, such as hydrocortisone. However, it is important to check that the products are safe to use on a baby's skin before applying.
In more severe cases, doctors may also prescribe stronger medications or specific drugs to target inflammation or the immune system itself.
For mild eczema, home remedies and changes may help control symptoms and avoid flare-ups. Home remedies for an infant with eczema may include:
- avoiding known or potential allergens, such as soaps, fragrances, or smoke
- cutting their nails often to help them avoid scratching
- considering soft mittens for their hands while they sleep to prevent scratching
- bathing them with mild soap or soap-free cleanser and lukewarm water
- using soothing ingredients in their baths, such as oatmeal or chamomile
- adding humidity to their room or sleeping area with a humidifier
Click here to learn more about home remedies for eczema.
Anyone who has concerns about their infant's symptoms should talk with their doctor for a full diagnosis. Additionally, if symptoms of eczema do not improve after a week with home remedies or over-the-counter medicines, it is advisable to contact a doctor.
Working closely with a healthcare professional can help to identify and eliminate possible triggers and find ways to reduce flare-ups or ease symptoms.
People should also call a doctor if they notice any signs of infection. This can include skin that oozes pus or dark crusts appearing on the skin. A doctor may be able to prescribe antibiotics to treat bacterial infections and help reduce symptoms.
AD is an inflammatory skin condition that is very common in infants, occurring in up to 30% of young children.
It typically appears in areas that may become dry and are prone to rubbing, such as the face.
Most treatments focus on easing symptoms of the condition, as well as preventing triggers to avoid flare-ups or make symptoms worse.
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