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Column originally published Mar 31, 2015

Infected Eczema

Question: Our two-month-old daughter developed rashes on her cheeks shortly after she was born. In the last few weeks, these rashes have spread to her scalp and her body. We saw little blisters which started oozing yellowish fluid. She has become much more irritable, and she constantly scratches her face. We went to a walk-in clinic; the doctor gave her an antibiotic cream which is not helping. Our friend said that this happened to her son also, and it is due to allergy. I am nursing her completely, and she has not eaten any food or drank any other milk. I wonder what she may be allergic to, and what can I do.


Your friend is correct.  Your daughter has eczema which is likely infected with bacteria.  Let me explain to you in more detail here.

Eczema is an allergic condition of the skin.  It is fairly common in infants and young children, sometimes even in adults.  The eczematous areas of skin are typically red, rough to touch, and quite itchy.  It can happen in any part of the body.  In older children who are allergic to some metals, contact with a button or belt buckle containing these metals can cause a patch of eczema called contact dermatitis.

In your daughter’s situation, if she has never consumed any food other than your breast milk, the source of allergy is likely in your breast milk.  This may be shocking to you, but it is very true.  The most likely cause of her eczema is cow’s milk protein allergy.  It comes from the dairy products that you eat or drink, either as cheese, yogurt, or cow’s milk.  Most mothers don’t recognize that the cow’s milk protein that is digested and absorbed from the intestinal tract can pass through the breast milk to their babies.  If a child has no tendency for this allergy, there is no problem at all.  However, if she is allergic, she can develop eczema within days to weeks after birth.

Most of the time, the first sign of eczema is on the cheeks of young babies.  At first, it looks like rosy cheeks; but over time, the skin is rough to touch, and often itchy, so that babies start to scratch their faces.

Once eczema begins, the skin loses its barrier to normal germs.  The most common bacteria that can cause secondary infection are Staphylococci.  When this happens, you will see blisters in and around the eczema, and yellow fluid can seep out of these infected areas.  It is a superficial infection.  If you recognize the source of allergy and eliminate it early, the skin can gradually heal and infection can get better without antibiotic treatment.

Antibiotic cream and ointment applied topically to eczema is not very effective.  Most of these topical antibiotics also have additional ingredients.  Babies can become sensitized to them.  The best way to treat is to use oral antibiotics which can fight the infection from within.

Topical steroid is often necessary to control the inflammation on the skin.  Occasionally, children may need oral steroid because of the severity of the eczema.  This should be guided by a paediatrician or dermatologist who is familiar with this condition.  Excessive use of topical steroid can cause some long-term complications on the skin.

Ultimately, you have to recognize that the underlying cause of eczema is likely food allergy.  Because you have nursed your daughter since she was born, the most likely cause of her eczema is cow’s milk protein allergy.  You should try to eliminate all dairy products from your diet.  This may include processed foods that have these proteins added to boost their protein content.  These may be labelled as casein or whey in the list of ingredients.  You need to eliminate dairy for several weeks to see whether it is helpful or not.

When you stop drinking milk or eating other dairies, you will have to make sure that you get enough calcium in your diet.  When you are nursing your baby, you can deplete your body, especially your bones, of calcium.  You may need to take calcium supplements as well as vitamin D, which helps to absorb calcium in our food.  Some mothers will drink soy milk and consume other soy products.  A small percentage of children who are allergic to cow’s milk are also allergic to soy.

When you stop taking dairy, it may take a few weeks before your daughter gets significantly better.  Some parents have found that bleach bath can help to reduce the severity of eczema on the body and extremities.  Once again, you need guidance from your doctor; too much bleach can cause skin irritation and make her condition worse.