There has been a dramatic rise in early infant atopic dermatitis or eczema – the most common chronic inflammatory skin disease in infants – during the last few decades.
The symptoms of eczema, with its dry, itchy and inflamed skin, can be a real pain for your baby – literally – as well as impact negatively on the quality of life of their carers. The disease is normally triggered in the first few months of life – although it can happen at any time – with symptoms that can range from mild to severe, and lead to secondary infections if not treated properly.
However, babies with eczema can benefit from early treatment, which can help with relieving symptoms and enabling them to lead a life of better health. When we look at the various reasons why babies are experiencing more eczema, it is essential to note that this paradoxical condition does not have one cause.
Instead, it is the result of a combination of genetic predisposition, environmental exposure and behaviour. Improved understanding of these factors may help to target interventions for infants with eczema more appropriately and guide efficient prevention and management.
Genetic factors
Eczema is a complex disease with a strong genetic component. Research indicates that if you come from a family with a history of eczema, allergies or asthma, you are far more likely to have a baby with the condition. For instance, if one parent suffers from atopic diseases, their offspring has a 60% risk of developing eczema.
This is usually related to the immune system, where genetic factors play a crucial role. An overzealous immune response can cause the skin to become inflamed and irritated by exposure to environmental triggers.
In addition, a lack of the protein filaggrin, often caused by genetic mutations and which is essential to the skin barrier, is a leading cause of eczema. Babies with such mutations are at greater risk of developing dry, sensitive skin that is vulnerable to eczema attacks.
Environmental influences
While genes play a large role in the condition, environmental factors also have a lot to do with the rise of eczema. Our environment currently exposes us to so many more forms of allergens than in the past, with dust mites, pet dander, pollen and mould among the top culprits.
The dust mite load has increased over the years due to urbanisation and changing patterns of household living. People are more likely to have a “direct contact” relationship with pets as many are allowed indoors, while the use of man-made materials in household goods encourages dust-mite infestation.
Those who live in urban areas are also more exposed to air pollution. Pollutants, including particulate matter, volatile organic compounds (VOCs) and ozone, may be responsible for skin irritation and skin barrier dysfunction.
Infants, who have delicate skin and developing immune systems, are likely to be particularly vulnerable. Urban living in general can also be stressful, with infant stress having direct and indirect effects on the management and worsening of their eczema.
Furthermore, the abundance of processed foods, with added artificial ingredients and preservatives, increases the chances of introducing new allergens to the baby. Processed foods can also modify the gut microbiome and immune response.
Research suggests that exposure to a wide variety of foods in infancy is crucial to developing a healthy immune system and can help build immunity to allergic conditions such as eczema. Indeed, it has been shown that early introduction of allergenic foods like peanut and egg can protect against food allergy, and by extension, eczema. But often, babies aren’t fed the foods soon enough, potentially leading to the manifestation of the allergy.
Lifestyle practices
The increase in the frequency of eczema is closely associated with certain lifestyle and care measures. A variety of factors can contribute to this, from what one applies on a child’s tender skin to one’s daily habits that impact the skin.
It is important for parents and caregivers to know how these activities can exacerbate or aid eczema. Skincare for babies is a jungle out there, as there are nearly as many soaps and shampoos for young ones as there are for adults.
Many are formulated with potential irritants like fragrances, preservatives and harsh chemicals. Even if some lotions and creams are formulated specifically for sensitive skin, they can also potentially trigger eczema.
The best solution is to find products that say “hypoallergenic for eczema-prone skin” and avoid the ones with added fragrances or dyes. Patch tests are also key when it comes to new products, as babies’ skin may be more sensitive to different formulations.
Just dab a little of the product on baby’s arm or leg to see if they develop any reactions before using it on their whole body. The regularity and method of bathing also plays an important role in skin hydration. Hot, lengthy baths can leave baby’s skin dry and irritated as it loses its oils.
Experts recommend that you give short, tepid baths before immediately applying a moisturiser to seal in water. And use a mildly-formulated, non-soap skin cleanser, to help minimise irritation. The trick is to maintain a well-hydrated skin barrier to prevent flare-ups and calm itchy, painful skin.
Stress can also cause a baby’s eczema – and their parents’ as well – to worsen. Babies are so sensitive to shifts in the environment and in the way they are cared for. Also, hyperstressed parents tend to be anxious and tense, indirectly impacting on the well-being of their child.
Simply keeping a regular schedule of calmness and peace, as well as care for the skin, will help reduce the risk of eczema, while also encouraging better skin health. As we have established, genes, environment and lifestyle are all at play, culminating into a complex quilt that is the appearance of our youthful skin.
By understanding and acting early on the sources of eczema, we can help improve the lives of affected babies, and make a difference in the health of our little ones.
By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 06 Oct 2025
