Eczema is common in infancy and generally begins between 2 and 4 months of age. This type of early onset eczema usually improves by the age of 2 to 3 years. The earliest sign in infants is usually an itchy, papular erythema on the cheeks. With rubbing and scratching, this may quickly develop into a weeping, crusting infected eruption on the face and scalp. In some children, rather diffuse red maculae spread to the trunk, diaper area and extensor surfaces of the limbs.
The onset is often related to the introduction of cow's milk, wheat or eggs. The infant develops urticaria, colic and a diffuse erythematous flush, followed by typical eczema. The lesions are always extremely itchy, and the resultant scratching can severely damage the skin. Non-allergenic factors such as infections, soap, woolen clothing, excessive sweating and emotional stress can cause exacerbations.
Babies with eczema are also highly susceptible to secondary skin infections. Comprehensive management of eczema in infancy includes: elimination diet; the prevention of trauma to the skin lesions by protecting the affected area from coming into contact with irritants and allergens and taking measures to prevent scratching; and treatment of secondary infections with appropriate antibiotics and topical steroids.