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Column originally published Mar 24, 1999
Column last revised/updated on Oct 23, 2018

Eczema Can Be Caused By Cows’ Milk Allergy

Question: Our daughter is four months old. She has very dry skin since she was born. In the last few weeks, she started a rash on her cheeks, around her neck, under her armpits, and behind her legs. She looks miserable, and her skin is breaking down. A friend said that she can be allergic to something. The only thing that she takes is formula. We haven’t even started her on any solid food yet. Is it possible that she is allergic to milk?

Answer:

What you have described is likely a condition called eczema. This is an allergic reaction to food, and the most common culprit is cows’ milk. This may surprise you, but let me explain in more detail.

Eczema is a type of allergic condition of the skin. You may also have heard of other forms of skin allergies, like hives (where the skin develops swollen blotches), and “contact dermatitis” (where the skin develops a rash when in contact with certain material).

Eczema can happen in young children as well as adults. When it happens in children, it is often very extensive. The skin of children with eczema has a tendency to feel rather dry, and this can happen shortly after birth.

The rash of eczema happens mostly on the cheeks, the chest and abdomen. Frequently, the skin at the creases can break down, like behind the ears, under the chin, in the armpits, as well as creases in the arms and legs. When the skin breaks down, it becomes red and swollen, and can be quite irritating to the child.

Children with eczema also tend to have a cradle cap on the head. There can be other signs of allergies, like frequent sneezing, vomiting or diarrhea, congestion in the nose, and even chest congestion, coughing and wheezing.

The most common cause of eczema is allergy to food. Most infant formulas are made from cows’ milk. It is interesting that many parents don’t know about this. Cows’ milk allergy is probably the most common food allergy in human. Given this fact, cows’ milk formulas are by far the most common cause of eczema in infants.

You may ask, can a test be done to find out whether cows’ milk is the cause of your daughter’s problem?  The answer is may be; tests may not be sensitive enough, and may be falsely negative.  Skin test is difficult to do on very young children. Blood test can help, but it is not always accurate.

The best way to manage your daughter’s problem is to stop giving her cows’ milk formula. What can you give her then? I would suggest that you try soy-based formula first. There are several of these formulas on the market which can safely replace her present formula. These soy-based formula can provide the necessary nutrition for her growth and development during her first year of life. There are also several highly digested cows’ milk formula; the cows’ milk protein is partially digested and may not trigger an allergic reaction in some of these children.

After you stop the cows’ milk formula, eczema will start to improve within a few weeks. Some of the more severely affected areas may need a mild steroid cream. You should check with your family doctor to find out whether such a cream is necessary. One word of caution — avoid using steroid cream on the face (unless if the eczema is severe there), because too much steroid cream can cause the skin to become thinner. As soon as eczema gets better, quickly reduce and stop the steroid cream.

Because her skin is dry, you can reduce the number of baths to two or three a week. She should spend as little time in water as possible. You can use a soap that has moisturizing cream in it. Applying Vaseline type of cream on her skin once or twice a day can increase moisture in the skin.

You may wonder how long you should keep her on these other formulas. There is no absolute rule, but generally I suggest using it until your child is about one year of age. At that time, you can try to change her to homogenized milk, which is made from cows’ milk. Watch for signs of allergies. Just remember, it may show up with other symptoms (like diarrhea or breathing problems) instead of eczema. Many children with cows’ milk allergy can outgrow the problem after the first year.

Some additional suggestions for those nursing mothers. Cows’ milk allergy can happen to your children also, if you drink cows’ milk or take other dairy products. Cows’ milk allergy is not limited to formula-fed babies. The dairy product that you take can be passed on to your baby through your breast milk. What you need to do is to stop taking all dairy products. You will need to talk to your doctor for advice on calcium supplements.

Finally, children with cows’ milk allergy can develop allergies to other things in future. Therefore, it is advisable that you watch her carefully.