Infantile Atopic Dermatitis: Causes, Symptoms, Treatment, and Prevention

What Is Infantile Atopic Dermatitis?

Infantile atopic dermatitis, also referred to as baby eczema, is a chronic skin condition that affects infants. It usually starts between 3 and 6 months of age. It causes the skin to be dry, red, and very itchy. The condition also tends to flare up and then go away, meaning that it can get worse for a while, then clear up, only to return in early childhood.

Infants usually get it on the cheeks, scalp, forehead, neck, and the outer edges of the arms and legs. The diaper area is not usually affected. The itching can be severe, leading to irritability, discomfort, and sleep problems in the infant.

Baby eczema often affects children with a family history of eczema, asthma, hay fever, or allergies. Most infants with this condition also have high IgE levels (a blood test that indicates an allergic tendency), which means their bodies are more prone to allergies.

What Causes Infantile Atopic Dermatitis?

The reason for infantile atopic dermatitis is not fully understood. It often occurs due to a combination of genetic, immune, and environmental factors.

Recent studies have found that some infants have a problem with a skin protein called filaggrin. This protein is important for maintaining the skin’s outer layer. If it does not work properly, the skin barrier will be weak. This will cause moisture to escape easily, making it easier for irritants and allergens to enter the skin.

In infants with this condition, the immune system will overreact. This will cause redness, swelling, and itching (inflammation).

Some environmental factors that may worsen symptoms include:

• Bathing in hot water.
• Using harsh soap.
• Being in dry air.
• Sweating.
• Infections.
• Dust mites.
• Smoke.

More recent studies have also found that an imbalance in the skin’s natural bacteria (the skin microbiome) and the presence of Staphylococcus aureus on the skin’s surface may cause flare-ups.

What Are the Symptoms of Infantile Atopic Dermatitis?

Symptoms of infantile atopic dermatitis can occur anywhere on the body, with the face, neck, elbows, scalp, and knees typically affected. Sometimes the symptoms of infantile atopic dermatitis also appear in the wrists, ankles, and hands.

Symptoms include regular flare-ups, and this condition is very common in babies between 3 and 6 months of age.

The common symptoms of infantile atopic dermatitis are listed below.

• Erythema, known as redness, is present.
• Scaly skin.
• Dry skin.
• Swelling.
• Skin is very thick.
• The skin is pale, particularly on the infants' faces.
• Small bumps are raised with a crusty surface, and when scratched, fluid leaks.
• Eyelids and the surrounding area appear dark.
• The skin around the mouth, eyes, and ears will show changes.

What Are the Complications of Infantile Atopic Dermatitis?

If infant eczema is left untreated, it can lead to complications. The most frequent complication of infant eczema is bacterial skin infection, especially caused by Staphylococcus aureus. The symptoms of infection include honey-colored scabs, small pus-filled bumps (pustules), redness, and swelling around hair follicles.

In some cases, infants can develop viral infections, such as eczema herpeticum. Other viral infections include eczema vaccinatum, coxsackie virus infection, and molluscum contagiosum.

Severe infant eczema can increase the chances of developing asthma, hay fever, or food allergies during childhood. This is known as the atopic march. However, parents should not remove foods from their baby’s diet without consulting a doctor.

The constant itching can also affect the infant’s sleep, making the infant uncomfortable. In some cases, chronic skin conditions can also lead to allergic contact dermatitis (skin reaction to certain substances).

What Is the Diagnosis of Infantile Atopic Dermatitis?

The diagnosis of infantile atopic dermatitis is primarily based on the baby's symptoms and medical history. The doctor will ask the parents about the baby's skin condition and whether there is a family history of eczema, asthma, or allergies. However, there is no test to confirm the condition.

To diagnose the condition, the doctor will physically examine the baby's skin to observe eczema symptoms. The doctor will also inquire about other allergy symptoms or exposure to potential allergens. In some cases, the blood test may show higher levels of immunoglobulin E (IgE), which may be an indication of an allergy. A skin allergy test may also be performed.

What Is the Differential Diagnosis of Infantile Atopic Dermatitis?

Symptoms of infantile atopic dermatitis are similar to those of other conditions. Comparison of symptoms with other conditions will help in differential diagnosis and avoid misdiagnosis.

The differential diagnosis of infantile atopic dermatitis is listed below.

• Contact dermatitis.
• Seborrheic eczema.
• The adverse effects of drugs.
• Infantile psoriasis.
• Scabies.
• Netherton syndrome.
• Ichthyosis Vulgaris.
• Mineral deficiencies such as zinc and biotin.
• SAM syndrome is called severe dermatitis, multiple allergies, and metabolic wasting syndrome.

What Is the Treatment of Infantile Atopic Dermatitis?

Treatment involves repairing the skin barrier, decreasing inflammation, alleviating itching, and preventing infections. The most crucial aspect of treatment is daily moisturization. Creams should be applied at least twice a day and after every bath to retain moisture in the skin.

During flare-ups, topical corticosteroids are used to reduce inflammation. Topical corticosteroids are safe to use in infants when used properly under a doctor's guidance.

Topical calcineurin inhibitors can be used in sensitive areas such as the face. Another non-steroidal alternative is crisaborole, which can be used in mild to moderate cases.

If there is a secondary infection, antibiotics may be needed. Sedating antihistamines can also be used to improve sleep in babies who have severe itching.

Recent developments in the treatment of atopic dermatitis include the use of Dupilumab in children as young as six months old with moderate to severe atopic dermatitis who do not respond to topical therapy. Current studies are also investigating the use of other biologic agents in children.

Can It Be Prevented?

Although it cannot always be prevented, flare-ups can be reduced. Bathing should be kept brief, using lukewarm water and mild soap. The baby’s skin should be patted gently dry and moisturized.

Cotton clothing is always preferred, and overheating should be avoided. Moisturizing in high-risk babies may reduce the severity of the condition.

Outlook

Most children tend to improve greatly by the age of five or six. Some may have mild symptoms throughout their life. The condition usually follows a pattern of flare-ups and remissions.

Conclusion

Infantile atopic dermatitis is a prevalent chronic skin disease characterized by itching, erythema, and dryness. Although there is no long-term treatment, good skin care, avoidance of the causative factors, and treatment can effectively control the condition. Early treatment can prevent complications and relieve discomfort. If the condition is severe, chronic, or recurrent, consult a skin specialist for further guidance.

Key Takeaways

• Infantile atopic dermatitis (baby eczema) is a chronic condition that causes itching of the skin. It usually begins when the baby is 3 to 6 months old.
• The skin is very sensitive and tends to dry out easily.
• Applying moisturizer to the skin daily helps to keep it healthy.
• Using medicated creams helps to control flare-ups. Severe flare-ups may require stronger medication.
• Early treatment and consultation with a skin specialist prevent infections and frequent flare-ups.