JOURNAL 10: Addressing Skin Irritations in Children

Skin irritations are very common in babies and young children. Most skin irritations are caused by exposure to common irritants/allergens or are caused by infection (i.e. fungal, viral, parasitic or bacterial infections).

Skin irritations can present very differently but typically appear as red, inflamed areas of skin with raised bumps, blisters and/or welts. Most skin irritations seen in babies and young children are mild and do not cause any significant distress, although symptoms such as pain and itchiness are quite common and need to be managed accordingly.

Some skin irritations seen in babies and young children are quite distinctive. Below are some of the more common skin irritations that present in clinical practice.

Eczema

Eczema is a form of dermatitis (skin inflammation) that typically presents as red, dry, cracked, inflamed skin which can be itchy and irritating. Eczema can affect any area of the body, however in babies and young children it is most commonly seen on the face, limbs and at the flexures of the neck, elbows, wrists, knees and ankles.

In babies and young children, genetic predisposition, hyperactivity or allergy to irritants (i.e. soaps, detergents, fabrics, chemicals), environmental triggers (i.e. dust mites, plant pollens, animal fur) and/or foods (i.e. cow’s milk, gluten, eggs) are the main causes of eczema.

As such, treating eczema begins with identifying and eliminating the individual triggers (irritant, environmental and diet) as well as any other potential factors exacerbating the skin irritation. Modulation of the immune system is also paramount to help control the inflammatory response.

Topically, it is important to support the skin’s hydration levels and protect the skin’s barrier to help lessen redness, inflammation, pain and itchiness to provide symptomatic relief.

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Cradle Cap

Cradle cap is a form of dermatitis (called seborrhoeic dermatitis) that involves the sebaceous (oil) glands within the skin. Cradle cap affects babies up to approx. three months old. After this, the sebaceous glands become inactive until the child enters puberty.

Cradle cap presents as thick, yellow, waxy or greasy, flakey patches or crusts, which are characteristically seen on the scalp but may also be seen in the eyebrows, at the back of the neck and behind the ears.

Cradle cap is caused by inflammation of the sebaceous glands, which are active and readily producing sebum at birth because of the strong influence of maternal hormones within the womb. Excessive sebum production is thought to cause inflammation of the sebaceous glands, and the fungus Malassezia has been implicated in some cases of cradle cap.

Cradle cap is not painful or itchy and usually self-resolves within a few weeks. As such, no direct treatment is required. However, many parents prefer to remove the patches or crusts because of their appearance and to prevent risk of infection.

It is important to note that the skin underlying cradle cap can become infected. If the cradle cap starts to ooze, weep, bleed or smell, there may be an infection present and this requires medical treatment.

To remove the patches or crusts, use a light baby moisturiser and/or a gentle baby shampoo to loosen and then gently lift the patches or crusts off with a soft brush or toothbrush. Repeat this process daily.

Nappy Rash

Nappy rash is a form of dermatitis that typically presents as a raw, red, inflamed skin rash affecting the area covered by the nappy, particularly the buttocks and sometimes spreading up toward the lower back. Nappy rash is generally sore, irritated and itchy, and babies will often appear irritable or unsettled.

Nappy rash is caused by exposure to frequent or constant moisture in the nappy (from urine and faeces) and/or the friction from nappy materials against the skin. Infections (i.e. yeast, bacterial infections) and personal care products (i.e. nappy wipes, scented soaps, baby lotions) can further irritate the skin and worsen nappy rash in some cases.

The most effective way to treat (and prevent) nappy rash is to ensure nappies are changed frequently as this keeps the skin clean and dry and minimises the amount of time urine and faeces are in contact with the skin. Good-quality disposable nappies are the better option as they absorb moisture quickly and more effectively compared to a cloth nappy. Allowing nappy-free time can also be helpful.

Topically, it is important to protect the skin’s barrier function to help lessen redness, inflammation, pain and itchiness to provide symptomatic relief.

If your baby or young child develops a skin rash, it is important to monitor this. If the rash does not improve, is not responsive to standard treatment/s, worsens/becomes more severe, and/or the baby or young child develops fever or vomiting, you should seek medical advice immediately from your GP or nearest hospital emergency department.