Baby Eczema on the Face: What to Use, What to Avoid and When to Worry

Red, dry, rough patches on a baby's cheeks are one of the most common reasons parents first come to see me. The face is often where eczema starts in babies, and because it's so visible, and so close to dribble, milk and little scratching hands, it can feel like the hardest place to get under control.

The good news is that facial eczema in babies usually responds well to a simple, consistent routine. Here's what I recommend.

The Short Answer

Use a fragrance-free emollient on your baby's face several times a day: after washing, before and after feeds, and before naps and bedtime. Keep the skin around the mouth clean and dry, avoid perfumed wipes and lotions, and don't use hydrocortisone on a baby's face unless a doctor has advised it. Get urgent advice if the skin becomes crusty, weepy or blistered, or your baby seems unwell.

Why Eczema Often Starts on the Face

In babies and toddlers, eczema very often appears on the face, especially the cheeks, before it shows up anywhere else. Older children are more likely to get it in the creases of their elbows and knees. There are a few reasons the face is affected first:

• Baby skin is thinner and loses moisture more easily than adult skin
• It's exposed to cold wind, central heating and sun in a way that covered skin isn't
• Dribble, milk and food sit on the skin around the mouth and chin many times a day
• Rubbing against bedding, car seats and your shoulder irritates dry patches

It typically looks like dry, rough, red patches on the cheeks, sometimes spreading to the forehead and chin. It's often very itchy, so you may notice your baby rubbing their face against you or the cot sheet.

Is It Eczema? Other Common Face Rashes

Lots of harmless rashes appear on babies' faces in the first months, and not all of them need cream:

• Milk spots (milia) are tiny white spots on the nose and cheeks of newborns. They clear on their own within a few weeks.
• Baby acne is small red or white spots that often appear a few weeks after birth and settle without treatment.
• Cradle cap is greasy, yellowish scales on the scalp, sometimes the eyebrows and behind the ears. It usually isn't itchy.
• Dribble rash is redness around the mouth and chin from saliva, common when teething. It's managed in much the same way as facial eczema.
• Heat rash is tiny red spots where your baby has got hot, which fade once they cool down.

Eczema is the one that is dry, rough and itchy, and keeps coming back in the same places. If you're not sure, your health visitor, pharmacist or GP can take a look.

What to Put on Your Baby's Face

Mild facial eczema is treated the same way as eczema anywhere else: with a fragrance-free emollient, used often. On the face, little and often works better than one thick layer a day.

• After washing: pat the skin dry and apply within a few minutes
• Before and after feeds: a thin layer around the mouth and chin before a feed acts as a barrier against milk and dribble. Reapply after you've gently cleaned the area.
• Before naps and bedtime, when your baby will be rubbing their face against the bedding
• Before going out in cold or windy weather

Smooth it on gently in the direction of hair growth rather than rubbing it in, and keep it away from your baby's eyes. If your emollient comes in a tub, take it out with a clean spoon each time so it doesn't get contaminated.

Around the Mouth: Dribble and Feeds

The skin around the mouth and chin often has the worst of it, because it's wet so much of the time. After feeds, and whenever your baby has been dribbling:

• Clean gently with lukewarm water and a soft cloth rather than fragranced wipes
• Pat dry; don't rub
• Apply a thin layer of emollient
• Use a soft cotton bib and change it when it gets damp

Once your baby starts solids, a thin layer of emollient around the mouth before meals can help protect the skin from acidic foods such as tomato and citrus fruit.

What to Avoid

• Fragranced wipes, lotions and baby washes. Perfume is a common trigger, even "natural" scents.
• Hot water. Lukewarm is kinder to dry skin.
• Aqueous cream. It isn't recommended as a moisturiser for eczema-prone skin.
• Over-the-counter hydrocortisone on the face. The NHS advises against using hydrocortisone on the face, or on children under 10, unless a doctor or pharmacist has recommended it. If your GP prescribes a steroid for your baby's face, use it exactly as directed.
• Overheating. Heat makes eczema itchier, so avoid too many layers at night.

Helping Your Baby Not to Scratch

• Keep their nails short and smooth
• Try scratch mittens, or a sleepsuit with fold-over cuffs, at night
• Dress them in soft cotton, and wash clothes and bedding in a fragrance-free detergent without fabric softener
• Keep the bedroom comfortably cool

When to See Your GP

See your GP or health visitor if:

• The eczema isn't improving after a couple of weeks of regular moisturising
• It's affecting your baby's sleep or feeding
• It's spreading to other parts of the body
• You think it flares after particular foods. Eczema in babies is sometimes linked to food allergy, particularly when it is more severe and hard to control, but please don't remove foods from your baby's diet without advice.

Get urgent advice from your GP or NHS 111 if the skin is blistered, crusty, weeping or has pus-filled spots, feels hot, swollen or painful, or suddenly gets much worse, or if your baby has a high temperature or seems unwell. These can be signs of infected eczema or of a more serious condition called eczema herpeticum, which needs treatment quickly.

For dry skin that isn't eczema, see Baby Dry Skin: Causes, Treatment & When to Worry. For choosing a cream, see Best Cream for Baby Eczema UK.

About Ovée

The Ovée Baby & Child Moisturising Cream is fragrance-free, paraffin-free and steroid-free, and suitable from birth. The 50ml size comes in an airless pump bottle that fits in the changing bag, so you can reapply after feeds when you're out. For bath time, the Gentle Oat Wash cleans without soap or SLS.

Dr. Tim Clayton is a Consultant Paediatric Dermatologist, President of the British Society for Paediatric and Adolescent Dermatology, and Co-Founder of Ovée Skin Health.