Skincare For Kids: A Pediatric Dermatology Expert Breaks Down Eczema And Cradle Cap
When my daughter was a newborn she had cradle cap, and while the skin condition didn’t seem to cause any discomfort, it certainly wasn’t pleasant to look at. I went through a lot of trial and error to try to figure out how to remove it, eventually settling on using a gentle cleanser and rubbing coconut oil on her every head day until the crusty patches of skin began to loosen up and finally went away. Unfortunately, we weren’t out of the woods completely. When my daughter turned two she developed eczema. She would go through phases of constantly complaining about being itchy and then she would break out in rashes. It got so bad that over-the-counter creams didn’t seem to work so I went to a dermatologist to help get her skin together.
I’ve written about multiple products that I’ve been able to incorporate into my daughter’s skincare routine, like Vaseline Clinical Care and Dove Calming Nights, but nothing’s better than actually getting insight from an expert. Parents know that dealing with our kids’ sensitive skin can be #strugglecity, especially if we feel like we’re not making progress, but we’re getting some answers today. I chatted with Dr. Mercedes Gonzalez, a pediatric dermatologist and resident expert at Dove, to get the scoop on eczema, dry skin, soap vs. cleanser, and the things we can do to ease cradle cap in infants.
MadameNoire (MN): My daughter is three now, but when she was two, she started to show symptoms of eczema and I keep hearing from a lot of other parents about how their children have eczema as well. Is it common for children to be eczema-prone?
Dr. Gonzalez (DG): Is there any history in the family of people with dry sensitive skin or allergies or asthma?
DG: Then that’s probably why. There’s a type of eczema that shows up early in life before five years of age called atopic dermatitis, and that one has a very strong genetic component. And by definition, it shows up very early in life and it presents with dry skin and sensitive skin that has a very low threshold for flaring up. Different things in the environment that contact the skin –and a lot of times it can be a routine in your daily things in your environment like sweat, or excess contact with water, so like, a prolonged bath, or water that’s too hot — those types of things can trigger flare-ups or little dry spots.
MN: Interesting. I have asthma, allergic rhinitis, and dry skin, and her father is prone to eczema, so she got a raw deal.
DG: She got the genes and her skin is drier. It’s different, but if you’re missing certain junctions that hold together the skin cells, the barrier of the skin is a little bit more porous and so it makes it easier for little things to penetrate the skin and trigger inflammation, pinkness, and redness of the skin, particularly itching.
MN: I noticed that when I took my daughter to the dermatologist, I kept calling it eczema and he kept calling it atopic dermatitis, which you mentioned earlier, but he never corrected me. Is there a difference?
DG: Eczema is the more broad term, and eczema is synonymous with dermatitis, and there are different types of dermatitis, so atopic dermatitis is the one that we’re talking about, which is the one that’s the hereditary type that presents early in life with a kind of relapsing type course where there’s sometimes itchy patches and sometimes there’s not.
Then there are other types like contact dermatitis, which would be the rash you get from poison ivy. Eczema and dermatitis are synonyms so with atopic dermatitis, the classic presentation are these pink to red, raised bumps, that have a roughness to them and they’re very itchy. By definition one of the hallmarks is that it’s an itchy area, and usually a lot of time the itch begins before you can see the rash. So, sometimes they call the condition, “the itch that rashes.” Typically it presents in very specific locations, so in a two-year-old, usually the spots are in the folds of the elbows, the backs of the knees, the face, the neck, the body—
MN: Ah, ok. My daughter mostly had it on her back, face, and torso.
DG: Yeah, those patches are triggered by different things as I mentioned.
MN: What are some of the best ways to care for kids with eczema, but also dry skin in general?
DG: Temperature of the water does matter! It should be warm, not hot, and this is more relevant for older children who are controlling the temperature. You want it warm, but you don’t want to steam up the mirror. Less than 10 minutes, and I do recommend daily baths especially once you’re not an infant anymore, like after 12 months, when the kids are walking and crawling and reaching into things, I think the benefits of a daily bath outweigh the risks of the drying effect of skin from too much contact with water, if that makes sense. As long as the bath is less than 10 minutes there’s not really much harm from a daily bath.
In the past, it was recommended to not bathe every day because it would dry out the, skin but as long as it’s less than 10 minutes, the benefits of cleansing and removing any surface dirt and bacteria are helpful. And of course, the cleanser choice is very important. You want to stick with cleansers as opposed to soap so those are words to look out for on the label, as well as sensitive skin and fragrance-free. The line Baby Dove is one that’s newer but they really were very thoughtful in making sure it’s mild and they’re sulfate-free and non-irritant.
MN: Does diet affect eczema at all?
DG: There is a lot of research going into that in terms of whether we can prevent the development of eczema in kids with prebiotics taken by mothers that are high risk, and probiotics taken after birth. Some studies show a correlation and other studies don’t so the jury is still out. At this time there are no recommendations in terms of diet changes to have any significant impact on the skin. It’s an area of active research, so there is probably some relationship there, we definitely know about the skin microbiomes so we’re learning a lot more about that. It’s very important to maintain healthy and diverse microbiomes on the skin because we have numerous bacteria and organisms on the skin that play a very important role in protecting us from the sun, from excess dryness, and help maintain moisture in the skin so you want to make sure the cleansers aren’t stripping away your extra microbiomes.
MN: Cradle cap in newborns is another common issue for parents. It’s harmless but seems alarming. What’s a good way to care for cradle cap?
DG: It’s something all babies get some version of, and I always like to tell my families that because, like you said, a lot of people are very alarmed, especially if the kid has more than average—but it’s something that goes away on its own. When it’s excessive, you do want to try to soften the scales and u can do that with something like the Baby Dove Shampoo, which has that quarter moisturizer; it’s very moisturizing. You can leave it on for maybe a half an hour or an hour to get it to soften up and then gently, in the bath, use a fine-tooth comb and gently pull it away. Don’t pull too hard, if it comes away easily, fine, if it doesn’t just do it for the next day and continue to try to soften it. If something like the Baby Dove Shampoo doesn’t work, you can try coconut oil, even a little olive oil—something to soften up the scales to make it easier for the parent to lift it off the scalp.
And if there’s underlying redness, and that’s considered a type of dermatitis—actually the medical term for cradle cap is seborrheic dermatitis, and sometimes in addition to having the scales you have a little bit of pinkness on the skin on the scalp, and sometimes it can cause some itching or discomfort. So, when there’s pinkness, that’s when you want to see a dermatologist because the baby might benefit from a medication like a topical corticosteroid for the pinkness. It’s the result of the hormonal peak that babies have early in life that can drop to low low levels at the end of the first year of life so as the hormones drop to low levels the cradle cap disappears. It’s something that all babies have. You treat it when it’s extensive or becoming an issue. Sometimes you don’t even need to treat it because it does go away.
MN: Finally, should parents make routine dermatology visits a part of their child’s overall well-being checks?
DG: Since I’m a pediatric dermatologist, I’m gonna say yes, I think it’s really important, especially when kids have some kind of dry background skin, but I think it’s helpful for kids that have some kind of skin condition, like some dry skin or eczema. I think early on, yes just to get guidance on appropriate day to daycare and how best to prevent flare-ups of eczema and how best to prevent infections. But if kids don’t have any background skin disease, it is still beneficial for them to visit a dermatologist to learn about some protection and caring for their skin. School-age years are a good time to visit, get an overall skin track, and have a discussion about healthy skin habits, like gentle cleansing, just like you brush your teeth. Every kid knows from a very early age that you want to brush your teeth twice a day, but a lot of kids don’t know that washing your face twice a day and putting on a moisturizer with sunscreen is just as important. I try to communicate that to my patients as early as they are able to comprehend that. Kids that have a lot of moles should come in too. I try to make sure those kids come in at least once a year so I can evaluate their moles.
Visit the Society For American Pediatric Dermatology for more information about how to take care of your child’s skin, visit.