Managing Pediatric Skin Issues: Seborrheic vs. Eczema

Medication issues, skin problems?

Hello doctor, my baby will turn four months old on November 7th and has not started solid foods yet.
After the first month, his skin condition worsened.
The pediatrician diagnosed him with seborrheic dermatitis, while the dermatologist said it is atopic dermatitis.
The dermatologist initially prescribed medication that improved his condition, but we know we cannot apply it continuously.
After he improved, we have been diligent in applying lotion.
At first, our baby did not scratch, but in the past two weeks, he has been scratching his neck, legs, and head vigorously, and he is also having trouble sleeping at night.
Currently, the pediatrician has prescribed Hydroxyzine for him to help alleviate the itching, to be given 3-4 times a day at a dose of 3cc.
1.
Is it harmful for him to take Hydroxyzine? He has been sleeping for long stretches after taking it, from midnight to 10 AM.
2.
Should I give him 3cc of Hydroxyzine? I found online that the dosage is based on weight, divided by 4 or 3, which would be 1.5cc or 2cc.
3.
If you do not recommend giving him Hydroxyzine, what should we do instead? We have been applying lotion regularly, changing his diaper frequently, about 3-4 times a day! We also use an air purifier.
4.
Which type of doctor should we consult next? He has been scratching himself to the point of bleeding, and despite regularly trimming his nails, he still manages to hurt himself!
5.
How can we determine whether it is seborrheic dermatitis or atopic dermatitis?
6.
He has red areas on his hands, feet, and neck, with yellowish fluid that forms into yellow crusts.
Is this indicative of atopic dermatitis? Does scratching mean it is atopic dermatitis?
7.
He also has red rashes on his hands, and his nails look wrinkled, resembling dyshidrotic eczema.
Should we take him to see a doctor again?

Mei Mei, 20~29 year old female. Ask Date: 2019/11/03

Dr. Xiao Kaiwen reply Pediatrics

1.
Occasional short-term use of hydrocortisone is not harmful for itching, but long-term management should focus on skin care to avoid dependency.

2.
Hydrocortisone has a wide safety margin; in more severe cases, a higher dosage may be permissible, so discuss this with your physician.

3.
Skin care for atopic dermatitis includes moisturizing lotions, bathing with lukewarm water (around 30 degrees Celsius), avoiding excessive heat and sweating, controlling dietary triggers, and managing environmental factors.
This is a complex topic, so please consult with your trusted physician.

4.
Seek a dermatologist familiar with infant atopic dermatitis or a pediatrician with a specialization in pediatric allergies.

5.
Seborrheic dermatitis typically improves with temporary application of ointments, whereas atopic dermatitis can have a long-term, fluctuating course leading to chronic rough, lichenified skin.

6.
Atopic dermatitis commonly occurs in specific areas; please consult your physician for more information.

7.
It is difficult to provide an assessment without seeing the actual skin condition; you may also consult your physician for further advice.

Reply Date: 2019/11/03

More Info

Managing pediatric skin issues can be quite challenging, especially when distinguishing between conditions like seborrheic dermatitis and atopic dermatitis (eczema). Both conditions can present with similar symptoms, such as redness, scaling, and itching, but they have different underlying causes and management strategies.

Seborrheic Dermatitis vs. Atopic Dermatitis:
Seborrheic dermatitis is often characterized by greasy, yellowish scales and is commonly found on the scalp (cradle cap), face, and behind the ears. It is generally not itchy and tends to resolve on its own as the child grows. In contrast, atopic dermatitis is associated with dry, itchy patches that can appear anywhere on the body, often exacerbated by environmental factors, allergens, or irritants. The intense itching can lead to scratching, which may cause secondary infections.

Given your baby's symptoms and the differing opinions from the pediatrician and dermatologist, it is essential to consider the following:
1. Hydration and Moisturization: Regardless of the diagnosis, keeping the skin well-moisturized is crucial. You mentioned applying lotion frequently, which is a good practice. Look for fragrance-free, hypoallergenic moisturizers that are suitable for infants. Applying moisturizer immediately after bathing can help lock in moisture.

2. Use of Medications: The use of topical steroids prescribed by the dermatologist can help reduce inflammation and itching. However, they should be used cautiously and not for prolonged periods to avoid potential side effects. If your baby is experiencing significant itching and discomfort, it may be necessary to continue using the prescribed medication as directed by your healthcare provider.

3. Antihistamines: The use of antihistamines like the one prescribed (likely an oral antihistamine) can help alleviate itching and improve sleep. However, always consult your pediatrician regarding the appropriate dosage based on your baby's weight. The general guideline you found (weight divided by 4 or 3) is a common method for calculating doses, but it’s best to follow your doctor’s advice.

4. Identifying Triggers: Keeping a diary of your baby's skin condition, including flare-ups and potential triggers (such as certain fabrics, soaps, or foods), can help identify what might be exacerbating the condition.
5. Consulting Specialists: If the condition worsens or does not improve with current treatments, consider seeking a second opinion from a pediatric dermatologist who specializes in skin conditions in infants. They can provide a more tailored treatment plan and help differentiate between seborrheic dermatitis and atopic dermatitis.

6. Signs of Infection: The presence of yellow crusty lesions and significant scratching leading to bleeding could indicate a secondary bacterial infection, which may require additional treatment. If you notice these symptoms, it’s essential to consult your healthcare provider promptly.

7. Understanding the Condition: The presence of red patches, especially if they are weeping or crusting, could suggest atopic dermatitis. However, seborrheic dermatitis can also cause similar symptoms. The distinction often lies in the distribution and characteristics of the lesions. For example, atopic dermatitis is more likely to affect the flexural areas (like the inside of elbows and knees), while seborrheic dermatitis is more common on the scalp and face.

In conclusion, managing your baby's skin condition requires a comprehensive approach that includes proper moisturization, careful use of medications, and monitoring for potential infections or triggers. Regular follow-ups with your healthcare provider will ensure that your baby receives the best care possible. If symptoms persist or worsen, do not hesitate to seek further medical advice.

Similar Q&A

Understanding Infant Skin Issues: Eczema vs. Seborrheic Dermatitis

Hello Dr. Wu, I have a history of allergies, and my baby may also have an allergic predisposition. My baby is almost five months old and has red, flaky, and dry skin, especially on the back. The areas that are usually scratched are the head and occasionally the chest, but the bac...

Dr. Wu Yuxin reply Dermatology
The diagnosis of atopic dermatitis requires long-term observation, and I also tend to think it is seborrheic dermatitis in infants. Generally, it improves around 8 to 12 months of age, but moisturizing may still be necessary. I recommend trying petroleum jelly.

Understanding Eczema: Diagnosis and Treatment for Children’s Skin Issues

Dear Doctor, I am very troubled by my child's skin issues, and my child feels embarrassed when interacting with peers. Is the diagnosis eczema and atopic dermatitis? The eczema on the fingers and the atopic dermatitis lesions have been recurring in ten different areas of th...

Dr. Zhang Zhibo reply Dermatology
Hello: "Eczema" broadly refers to dermatitis, characterized by symptoms such as redness, swelling, and itching. "Atopic dermatitis" is actually a chronic, recurrent allergic inflammatory skin disease. There are certain diagnostic criteria that must meet at lea...

Seeking Help for Skin Allergies and Ulcers in Toddlers Under 3

For a child under three years old experiencing skin allergies and ulcers, it is advisable to seek help from a pediatric dermatologist or a pediatrician with experience in dermatological conditions. If the child has been diagnosed with atopic dermatitis (eczema) and the condition ...

Dr. Xie Degui reply Pediatrics
Hello: The child has a skin allergy predisposition that leads to atopic dermatitis, characterized by redness and scaling. It is particularly prone to occur on the child's face, torso, and areas of the arms and legs that can be scratched, causing intense itching which leads t...

Differentiating Atopic Dermatitis from Seborrheic Dermatitis

How can we differentiate between atopic dermatitis and seborrheic dermatitis?

Dr. Zheng Lizhen reply Dermatology
Atopic dermatitis commonly occurs during childhood and often has a family history of allergic conditions such as asthma, allergic rhinitis, and atopic dermatitis itself. Seborrheic dermatitis can occur in infancy as well as in adulthood and does not necessarily have a family hist...