Tea-Time Talk: Eczema Q+A

Every afternoon at the farm, I make a cup of matcha and sit down for a little “tea-time talk” with you — a quiet moment to pause, breathe, and answer your most common questions from the week. Think of it like chatting with your pediatrician at the kitchen table: calm, cozy, and filled with reassurance.

If your little one’s skin has been red, itchy, or flaring this week, you’re in the right place. Today’s tea-time talk is all about eczema — what causes it, how to soothe it, and what really helps day-to-day.

1. Understanding Why Eczema Happens

First things first: what causes eczema, and does it always mean there’s a “root cause” like a food allergy or gut issue?

What’s going on in the skin?
Eczema is primarily a skin barrier issue. Children with eczema often have reduced levels of key barrier proteins (like filaggrin) or lipids (such as ceramides) in their skin-outer layer. This means moisture escapes more easily and irritants or allergens enter more easily. HealthyChildren.org+2PMC+2

Because the barrier is weakened, skin becomes dry, red, itchy — and prone to flares when triggered.

What about gut-related causes or allergies?
You asked: “Is it always or mostly gut related?” and “Can eczema just happen on its own? I feel like I always see it related to CMPA for infants?”

The short answer: while food allergies or gut issues may co-exist with eczema, in most cases eczema arises independently, from skin barrier + immune + environmental interactions. The updated American Academy of Pediatrics (AAP) guidelines emphasise that blindly eliminating foods isn’t recommended unless allergy testing and clinical correlation exist. AAP Publications+1

Where to start if you want to look for “root causes”?

You asked: “Where to start when looking for the root cause?”
Here’s a practical plan:

1. Ensure basic skin-care and barrier repair (see section 3 & 4 below) — because if the barrier is weak, everything else suffers.

2. Review possible irritants/triggers (see section 5).

3. If flares are frequent, severe, or associated with other allergic signs (food reactions, asthma, allergic rhinitis), then talk to your pediatric dermatologist or allergist about tests (skin-prick, patch testing) or dietary review. The AAP urges referral for “complicated” eczema. Drugs.com
   In other words: yes, look broadly, but don’t assume a single root like “gut” unless the clinical picture points clearly that way.

2. Common Locations & Everyday Care Challenges

You also asked many location-specific questions — great! Let’s group them by common tricky spots and how to care for them.

Rear diaper-line, back, neck, ears, chin

• “My 1 year old has it right on diaper line in back so always irritated – tips or tricks”

• “2 year olds skin behind ear is cracked and bleeding - nothing has worked!”

• “Eczema on back hard to reach to moisturize so gets dry and flares up – tips?”
  These areas share a common theme: folds or places exposed to friction, moisture, or dryness.
  Tips:

  • For diaper/crease areas: Use very gentle barrier creams (fragrance-free), frequent diaper changes, and ensure the skin is cleansed with mild cleanser, patted dry, then immediately moisturized.

  • For behind ears/neck/back: Use “reach-friendly” tools (e.g., a long-handled soft-glove or bath mitt) to apply moisturizer right after bath while skin is still damp. Focus on thick cream or ointment form (see product examples later).

  • Keep clothing loose, breathable cotton, avoid synthetic fabrics that trap sweat or rub skin.
    The AAD (American Academy of Dermatology) self-care guidance emphasises gentle cleansing, avoiding scrubbing, and applying moisturizer immediately after bath. American Academy of Dermatology+1

Hands when you must wash them

“How to help with bad flares on hands when you need to wash them, it’s a rough cycle!”
When children (or you!) must wash hands frequently:

• Use a mild, fragrance-free hand cleanser.

• After each wash (or at minimum 2–3 times a day), apply a thick moisturizer or hand-cream formulated for eczema-prone skin. Tips: I like to use nipple balm like this for hands and mouth areas — this way, if it gets into their mouth, you don’t have to think too much about it.

• At night, consider “wet wrap” or glove + cream combo to reduce scratching and support barrier. AAD endorses wet wrap therapy for children with severe flares. American Academy of Dermatology

• Use fragrance-free gloves if needed for chores that include water, soaps, or chemicals.

Face/chin/around eyes

“RX steroidal cream okay on chin area or Rx tacrolimus? Why?”
“Itching and redness near eyes”
Faces and near-eye regions have “thinner” skin, which means we are more cautious. According to AAP and other guidance, lower potency topical steroids or non-steroidal options (e.g., topical calcineurin inhibitors like tacrolimus) are preferred for sensitive areas (face, intertriginous zones). AAP Publications+1

When you see redness near eyes:

• Avoid cream that stings or burns (we’ll cover how to choose a moisturizer).

• Use non-steroid alternatives if frequent flaring in this area, and discuss with your dermatologist.

• Always protect from rubbing/scratching; keep nails short.

General flare during virus or illness

“Is it common for eczema to flare when 1 year old is fighting a virus?”
Yes. Viral illness, fever, even dry indoor heating during illness can trigger flares — because skin is stressed, immune system activated, moisture barrier more vulnerable. The AAP emphasises trigger-avoidance plus proactive anti-inflammatory care for flare prevention. guidelinecentral.com+1

3. Treatment Options: Steroids, Tacrolimus, and Beyond

Let’s walk through how treatment fits in alongside basic skin care.

Moisturizers + barrier repair — the foundation

Before any prescription, the foundation is regular, liberal moisturizing. Guidelines show that daily emollient/cream use reduces flare frequency and supports skin healing. AAP Publications+1

Research shows that moisturizers containing barrier lipids (like ceramides) help correct the biochemical defects in eczema skin. PMC+1

When choosing, follow these principles:

• Thick creams or ointments (rather than thin lotions) are more effective. HealthyChildren.org

• Fragrance-free, dye-free, hypoallergenic. empr.com

• For younger children, apply at least twice a day or more (especially after bath). American Academy of Dermatology

These are some of my favorite products — simple, effective, and recommended by our dermatologists.

Use whichever fits your child’s age, skin feel, tolerability, and budget—but remember: consistency matters more than the “perfect brand”.

Topical steroids and non-steroid alternatives

You asked: “RX steroidal cream okay on chin area or RX tacrolimus? Why?” and “Skin thinning with steroid use is it reversible?”

Here’s how I explain it to families:

• Topical corticosteroids (TCS) remain first-line for active flares in children (especially moderate-severe). PMC+1

• For sensitive locations (face, eyelids, neck, diaper area) or frequent recurrences, topical calcineurin inhibitors (TCI) like tacrolimus/pimecrolimus are valid steroid-sparing options. AAP supports this. AAP Publications+1

• Skin thinning (atrophy) is very uncommon with proper low-potency steroid use for short courses in children. The AAP update states typical use does not alter pigmentation or barrier long-term. conexiant.com
  So: Yes, steroid cream can be okay on the chin (with your dermatologist’s guidance) — but choose low potency, apply briefly, monitor. Tacrolimus may be considered if area is delicate or flares frequently.

Why isn’t ivermectin cream recommended for eczema?

You asked: “I see ivermectin cream works for eczema — why isn’t it doc recommended?”
Good question. Ivermectin is an antiparasitic/anti-mite treatment, not a standard eczema anti-inflammatory. Eczema is immune-mediated, barrier-defect driven, not primarily driven by mites in most children. There’s no robust pediatric guideline recommending ivermectin for eczema. Until high-quality trials emerge, we stick with evidence-based therapies (moisturizers, steroids, calcineurin inhibitors, trigger avoidance). The AAD guidelines emphasise what is strongly recommended and say clinicians should be wary of unvalidated off-label therapies. American Academy of Dermatology

When to start hydrocortisone (and how)?

“When and how to decide when you need hydrocortisone to treat”
Hydrocortisone 1% (over-the-counter) may be appropriate for mild localized flare-ups (e.g., one small patch behind ear) for a few days—provided you have pediatrician approval. But if the area is large, recurrent, or involves face/eyelids, the stronger prescription options/dermatologist review are better. Use the “lowest effective potency, for the shortest duration”, monitor response, and always combine with moisturizer. The AAP emphasises applying topical anti-inflammatories to active patches and not mixing them with emollients unless directed (as this dilutes potency). guidelinecentral.com+1

4. Home & Natural Remedies That Really Help

There is no replacement for good skin-care + evidence-based treatment — but yes, many practical home tools can reduce flares, minimize steroid use, and support comfort.

Choosing a lotion that doesn’t burn

“Is there a lotion that doesn’t make eczema burn?”
Yes. Many children find that “traditional” fragranced lotions sting when skin is cracked/inflamed. Aim for: thick cream or ointment, fragrance-free, dye-free, ideally labelled for “eczema-prone skin”. The research on ceramide-rich moisturizers supports barrier repair and fewer irritant reactions. PMC+1

You can also try using something like Active Skin Repair first to help heal the skin barrier and then cover with a thick ointment.

Start with something mild on your child’s skin (e.g., one of the examples above), apply a patch to a small area, then use widely.

Natural or “steroid-free” flares management

“Is there a natural way to get rid of bad flares besides steroids / Best at home remedies for flares”
Here are steps:

1. Moisturize immediately and often — Apply thick cream within 3 minutes of bath, and again 2–3 times per day.

2. Bathing strategy: Lukewarm water, 5–10 minute maximum, use mild non-soap (fragrance-free), pat dry, moisturize right away. American Academy of Dermatology+1

3. Avoid scratching: Keep nails short, consider cotton gloves at night. AAD recommends this. American Academy of Dermatology

4. Wet-wrap therapy for severe flares: Apply topical treatment + moisturizer, then cover with damp cotton layer + dry layer. Helps calm scratch-itch cycle. Good to ask dermatologist.

5. Environmental/trigger control: Dry air (use humidifier), sweating (remove excess clothes), allergens/pets, fragrances in detergents, rough fabrics. AAP emphasises trigger-avoidance. conexiant.com+1
   These steps don’t always replace steroids for moderate or severe flares — but they can reduce how often you need them, help keep skin calmer, and support longer flare-free stretches.

Scrub or not to scrub?

“To scrub or not to scrub with washcloth dirty areas that flare up”
Short answer: Do not scrub aggressively. Use a soft mitt or your hand, not a rough washcloth or sponge. Cleansing should be gentle, especially in flare areas. The AAD recommends avoiding scrubbing and keeping bath time short. American Academy of Dermatology

Is Aquaphor good or bad for eczema?

“Is aquaphor good or bad for eczema?”
Aquaphor (petrolatum-based ointment) can be good in many cases — it forms a barrier to lock in moisture and protect cracked skin. However, it does contain lanolin, which can be a common cause of contact dermatitis, so we may recommend simple Vaseline instead if your child is not reacting well to it.

Is Keratosis Pilaris related?

“Is Keratosis Pilaris related?”
Keratosis Pilaris (small rough bumps on upper arms or thighs) is a separate condition, though it can co-occur in children with dry skin or eczema. It is not the same as eczema, and treatment strategies differ. If uncertain, your dermatologist can help distinguish.

Can eczema be “flesh-colored”?

“Can it be flesh colored?”
Yes — especially in children with skin of colour or when the flare is subtle. Sometimes the redness is less obvious; you may see slight bumps, scale, or dry texture. Trust your instincts—if the skin feels different, itchy, or cracked, treat it as eczema. AAD guidance notes that eczema presentation can vary by skin tone. PMC

5. Triggers, Allergies & Flare Patterns

“How to tell difference between allergies and eczema reaction/flare if child has both?”
“If one sibling has eczema, how likely are siblings?”

Differentiating eczema vs allergy reaction:

• Eczema flares often appear in characteristic locations (face, neck folds, creases, arms/back), are chronic or relapsing, and improve with barrier care + topical anti-inflammatories.

• True allergic reactions (food, contact) may appear abruptly after exposure (within minutes–hours), may include hives, swelling, respiratory symptoms, or distinct patterns (lips, immediate rash).
  If both are present, your dermatologist/allergist may recommend patch testing, blood/skin-prick allergy testing, and detailed history. AAP emphasizes that not every child with eczema needs broad food elimination. AAP Publications

Sibling risk:
Yes — eczema has a genetic component. If one sibling has eczema, the chance of another child having it is higher compared to the general population. Exact percentages vary, but sharing of atopic conditions (eczema, asthma, allergic rhinitis) is common in families. You can take preventive care (consistent barrier moisturizing, early avoidance of irritants) from infancy to reduce severity.

6. Long-Term Management & Prevention

Here’s how to keep skin calm, manage the chronic nature of eczema, and support your family long-term.

“How to keep skin so it’s never on the brink of needing steroids?”

• Daily moisturizer (even when no visible rash) is foundational.

• Use anti-inflammatory topicals proactively in previously affected zones (for example, twice-weekly after initial flare resolves) — AAP guidelines call this proactive therapy. rheumatologyadvisor.com+1

• Monitor seasonal triggers: winter heating, low humidity, viral illness = higher risk. Increase moisturizer frequency accordingly.

• Have a written “eczema action plan” (bath-plus-moisturize routine, when to use anti-inflammatory, when to call your doctor).

• Educate caregivers/teachers: Use fragrance-free soap, make sure you have fragrance-free laundry detergent (I like these options), avoid fabric softeners, ensure skin isn't excessively sweaty or overheated.

Post-flare brown patches (post-inflammatory hyper- or hypo-pigmentation):

“Baby now has brown patches where the initial rashes/flare ups were? How can I handle this?”

After inflammation, skin can leave discoloration (brown or lighter patches). Over time (months) it usually fades, especially with sun-protection and healthy skin care. Continue barrier repair, avoid scratching (which prolongs inflammation), and be gentle. Use sunscreen regularly for babies older than 6 months. If discoloration persists, your dermatologist may discuss topical pigment-modifying treatments, but often patience + prevention is key.

Chronic eczema since infancy (e.g., 2-year-old worsening in winter):

“Long-term topical recs? 2 year old with chronic eczema since infancy, worsens in winter/during illness”

Yes — the approach here is: maintenance moisturizer daily, identify seasonal/illness patterns, use proactive anti-inflammatory therapy in known affected zones, and have early flare-management steps (bath, moisturizer, anti-inflammatory). Keep a close watch for signs of infection (yellow crusting, pus). The AAP underscores the three-pillar approach: barrier care + anti‐inflammatory + trigger avoidance. empr.com+1

7. When to Call Your Pediatrician or Dermatologist

Here are red-flags and guidelines for escalation:

• Rash is extremely painful, bleeds, oozes pus = possible skin infection.

• The eczema covers large body areas, is unresponsive to your current routine for 1–2 weeks.

• Eyelid/face involvement with swelling, vision changes.

• Frequent flares (e.g., every few weeks) despite consistent care.

• Significant sleep interruption, behavioral/psychosocial impact.

• Consider referral if you might start systemic therapies or biologics. AAP suggests early collaboration with specialists for complicated cases. aap.org+1

And Just Remember…

Eczema in young children can feel overwhelming—but the good news is you’re not starting from zero. By focusing on gentle, consistent skin-care, understanding when and how to use anti-inflammatory treatments, and taking a proactive approach to triggers, you and your child can build calmer, more resilient skin.

If you ever feel stuck, remember: the most effective treatment is the one your child will do consistently. Choose products they tolerate, routines that fit your life, and know that each moisturizer moment, each gentle cleanse, and each “we’ll handle this patch” step adds up.

Stay calm, stay consistent - you’re doing so great. Just take it one step at a time.

Sending you a big hug,

Anjuli

Disclaimer: This blog post is for informational purposes only and should not replace the specific instructions provided by your child's surgeon or healthcare provider. Always follow the post-operative care instructions given by your medical team.

References:

1. American Academy of Pediatrics. Atopic Dermatitis: Update on Skin-Directed Management. Pediatrics. 2025. AAP Publications+2rheumatologyadvisor.com+2

2. American Academy of Dermatology. Atopic Dermatitis (Eczema): Self-care and Treatment in Children. American Academy of Dermatology+1

3. Elias PM, Sugarman J. Moisturizers vs Barrier Repair in Atopic Dermatitis. JAAD Reviews. 2025. PMC+1

4. Additional peer‐reviewed articles on pediatric atopic dermatitis treatment and management. PMC+1