TCM doctor explains causes of and how to care for baby eczema

A newborn's skin is supposed to be soft, smooth, and delicate. But when red, oozing patches appear on the face or inner elbows, it's heartbreaking to see. Registered Chinese medicine practitioner Dr. Yip Ho-yin explains the causes of pediatric eczema, along with medication and daily care advice. He cautions that if a mother eats too many spicy or fried foods during pregnancy or while breastfeeding, it can increase her child's risk of developing eczema.

What Causes Pediatric Eczema? Can a Mother's Diet During Pregnancy/Breastfeeding Play a Role?

Yip shares a case study involving a 6-year-old boy. Upon entering the consultation room, the doctor immediately noticed the child was very thin. The boy's mother explained that when spring arrived with the changing seasons, his forearms became red and intensely itchy. Although she applied moisturizer, his skin became dry and flaky. The boy couldn't resist scratching constantly. By the time of his appointment, his arms were covered in scratch marks and wounds, with some areas oozing fluid.

After diagnosis, Yip determined the boy had a pattern of "spleen deficiency with dampness accumulation, combined with blood deficiency giving rise to wind." After one month of adhering to herbal medication and topical application of Purple Cloud Salve (Ziyun Gao), the boy's eczema had largely resolved.

Yip notes that pediatric eczema can appear anywhere on the body but is most common on the inner folds of the limbs, the face, and the neck. Eczema lesions are typically symmetrical and present with itching and dryness. Scratching may produce flaking scales; broken skin can become eroded and ooze fluid, with scabs that are slow to heal. If the condition persists, the affected skin may thicken, become rough, and even develop a leathery, lichenified appearance.

Why Are Children Prone to Eczema?

• A child's spleen and stomach are not fully developed, impairing their ability to metabolize and transport body fluids (dampness).
• Children sometimes enjoy snacks or other hard-to-digest foods, which overload the spleen and stomach.
• Humid spring weather easily triggers skin problems. Children scratch when itchy, damaging the skin and making healing more difficult.
• If the mother eats spicy, fried, greasy, or "trigger" foods during late pregnancy or breastfeeding, she may transfer internal damp-heat to the baby, increasing the risk of pediatric eczema.

How Do Western and Chinese Medicine Approaches to Eczema Differ?

Western Medicine Approach

• For mild eczema: Doctors typically prescribe aqueous cream or emulsifying ointment for moisturization.
• For severe eczema: Topical corticosteroids or antihistamine creams may be prescribed.
• Caution: Long-term steroid use can thin the skin and cause redness, so these must be used carefully under medical supervision.

Chinese Medicine Approach

TCM practitioners prescribe different formulas based on the stage of eczema:

• Red, inflamed, itchy skin: Focus on clearing heat and cooling blood. Common herbs: Sheng Di Huang (Rehmannia root), Zi Cao (Arnebia root).
• Dry skin with scaling: Focus on nourishing blood and dispelling wind. Common herbs: Dang Gui(Chinese angelica root), Jing Jie (Schizonepeta).
• Blisters with oozing fluid: Focus on promoting diuresis and draining dampness. Common herbs: Tu Fu Ling (Smilax glabra), Bi Xie (Dioscorea hypoglauca).
• Given that children inherently have "spleen insufficiency," spleen-strengthening herbs such as Dang Shen (Codonopsis), Huai Shan (Chinese yam), and Mai Ya (barley sprout) are often added.
• For dry, non-oozing eczema: In addition to Western moisturizers, the topical TCM preparation Purple Cloud Salve (Ziyun Gao) can be used. Zi Cao (Arnebia) clears heat, cools blood, relieves itching, and detoxifies; Dang Gui (Angelica) tonifies and invigorates blood, promoting circulation and accelerating skin repair.

At What Age Can Children Begin Taking Chinese Herbal Medicine?

Yip explains that children can take Chinese herbal medicine once they have normal swallowing ability. Generally, if clinically indicated, infants as young as 3 months old may take herbal medicine. The key factor is whether the condition truly requires medication. Children's dosages are proportionally reduced based on age, typically 1/2 or 1/3 of the adult dose.

In terms of formulation, practitioners may add sweet-tasting herbs such as red dates (Da Zao), licorice (Gan Cao), or hawthorn berry (Shan Zha) to improve palatability. If a child strongly refuses the medicine, for those aged 2 or older, half a teaspoon of honey can be added. Important:Children under 2 years old should not be given honey, as it may contain botulism spores that can produce toxins in an infant's immature digestive system.

Daily Care Tips for Pediatric Eczema

How can parents help their child manage eczema on a daily basis? Yip offers five key recommendations:

1. Keep fingernails short to reduce the risk of infection from scratching.
2. Avoid soaking in baths. Limit showers to 10 minutes or less.
3. Apply moisturizer immediately after towel-drying the skin.
4. Dress the child in loose-fitting clothing.
5. Use a dehumidifier at home to keep the indoor environment dry and well-ventilated.