lcp
We have detected you are using Internet Explorer. To provide the best and most secure experience, please use a modern browser as we do not support Internet Explorer.
Blog post branding logo

Facial eczema in an infant - Clinical Opal

18 March 2024 - Quality Use of Medicines Alliance

Emily is a 6-month-old child who presents with red, papular, excoriated patches on her cheeks and around her mouth.

Her father, Craig, says a mild rash has been there ‘for a while’ but started to look a lot ‘angrier’ about three weeks ago. He tells you that Emily has also started to scratch a lot, and has drawn blood a few times in her sleep, so they now put mittens on her hands.

Craig took over parental care about 4 weeks ago. He gives Emily formula during the day and she is also trying a small amount of pureed fruit and vegetables. Emily is still breast-fed morning and night. He and Emily’s mother wonder if she could have a food or formula allergy. 

On examination, you note an erythematous rash showing typical distribution for facial eczema, including lighter erythema along the hairline. The skin around the cheeks is dry, excoriated and crusted. There is no active weeping from lesions or signs of infection. You can see the top of her left lower central incisor has broken through the gum. You learn that Emily’s mother had eczema when she was a child, but ‘grew’ out of it. Using a scoring tool (e.g. vIGA-AD), you determine that Emily has moderately severe facial eczema.

What treatment do you recommend, and how do you address the parental concerns regarding food allergies contributing to the baby’s eczema?


Eczema (atopic dermatitis) is a common, chronic inflammatory skin condition that often starts in infancy.

While there is no cure, most cases can be controlled with regular and appropriate foundational care, which includes moisturising every day and avoiding triggers.

Given the moderate severity of Emily’s eczema, it would be appropriate to prescribe methylprednisolone aceponate 0.1% cream, to be generously applied to all affected areas, once daily for no more than 7 days. If eczema has not cleared, step down to hydrocortisone 1% or consider a topical calcineurin inhibitor until the skin is smooth and itch-free.

Provide Craig with an eczema care plan that includes written guidance for both parents to follow and a review date. If time permits include a demonstration of how to correctly apply topical treatments, or have Craig ask the pharmacist to demonstrate.

Include a discussion on bathing, daily moisturising and reduction of likely triggers. Dribbling associated with teething is also likely to irritate surrounding skin. Keeping the area well moisturised with a greasy barrier (e.g. Vaseline) before and after feeding should help. Clean her mouth using a soft wet towel (avoid wipes containing fragrance or preservatives such as MCI/MI). Some foods (e.g. citrus fruits, strawberries, tomatoes, tomato-based sauces) also irritate the skin around the mouth—this is not a food allergy.

Most food allergies cause symptoms (e.g. hives, vomiting and irritability) within 30 minutes of consumption. Only occasionally do they result in delayed eczema flare-ups. Modifying diet (i.e. restricting diet, changing formula) has little benefit. Elimination diets in children who do not have a confirmed food allergy can cause malnutrition and poor growth and result in the development of new food allergies. 

Skin prick or RAST tests do not predict foods that trigger eczema and should only be undertaken if recommended and interpreted by a clinical immunology/allergy specialist.

Some evidence suggests that managing eczema well during infancy may reduce the chance of an infant developing food allergy. 

More on the quality use of medicines 

QHUB is Medcast's new dedicated platform for education and resources that support safe and appropriate use of medicines. 

Click the logo to find out more!

Related courses

The Eczema Equation: Burden of disease and challenges in management (webinar)

Virtual Educational Visiting

QUM alliance

References

Atopic dermatitis (published August 2022). In: Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. Accessed 28 Sep 2023. https://www.tg.org.au

Australasian College of Dermatologists. Consensus statement: Topical corticosteroids in paediatric eczema. 2022. https://www.dermcoll.edu.au/wp-content/uploads/2022/09/ACD-Consensus-Statement-Topical-Corticosteroids-September-2022-.pdf

The Royal Children's Hospital Melbourne. Eczema: Clinical Practice Guidelines. https://www.rch.org.au/clinicalguide/guideline_index/eczema/

Eczema and food allergy - fast facts [Internet]. Australasian Society of Clinical Immunology and Allergy. 2024. https://www.allergy.org.au/patients/fast-facts/eczema-and-food-allergy

Quality Use of Medicines Alliance
Quality Use of Medicines Alliance

The Quality Use of Medicines Alliance a consortium of eight health and consumer organisations, will align their work across the two grants, awarded under the Australian Government’s Quality Use of Diagnostics, Therapeutics and Pathology (QUDTP) Program.  

FOLLOW QHUB

Receive QHUB updates to your inbox.

Or follow us on social media

Related Tags
Related Categories
Latest News
The ABCDE of post resuscitation care

Following 10 minutes of CPR and two shocks for VT, Nadia shows signs of life. After the third rhythm check, with respiratory effort noted, the defib was disarmed using the COACHED sequence. What is the next step in determining the plan of care for Nadia?

5 mins READ
PODCAST: Addressing disease burden, risk factors and health behaviours in Australian males aged 18-44

Men’s Health Week is June 10 -16 2024. Listen in to this podcast to learn about what is impacting the health and wellbeing of Australian men and how we can support males to adopt healthy behaviours.

35 mins READ
Does Hafiz need a referral for allergy testing?

Hafiz, a 13-month-old, developed a rash and swelling around their mouth after eating peanut butter, displaying signs of a potential IgE-mediated food allergy. What are the next steps for Hafiz?

5 mins READ