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What is the rash on the back of my 5-month-olds neck?
Q: My 5-month-old has a rash on the back of his neck that keeps going away and coming back. His pediatrician thinks it's eczema, but I thought eczema was bumps. His is a round pink rash. The pediatrician gave me a cream for it, but after two weeks of using it, the rash came back. I don't think it's eczema. What else could it be, and how do I get rid of it for good?
A: Sherita, it’s impossible for me to diagnose your baby’s rash without seeing it, but from your description it does sound like eczema, as your pediatrician said.

Eczema, also known as atopic dermatitis, is a common skin rash that affects approximately 5-10% of children. Eczema is a type of skin sensitivity or allergy, and can be hereditary—it’s most common in families where one or both parents have eczema, allergies, or asthma. The eczema rash has many different appearances from white or pink patches to bumps, blisters, scaling, and oozing. Over time, the skin can become thickened, dry and darker. In infants and young children, the rash typically appears on the face, scalp, abdomen, arms, legs, and skin folds such as elbows, knees and neck. The hallmarks of eczema are that the rash itches, and it comes and goes. Thankfully, at least half of children with eczema end up outgrowing it.

Here are some basic tips for caring for your baby’s eczema:
  • Try to figure out what’s causing the eczema and try to avoid it.

    • In 10-25% of cases, the eczema may be caused by a food allergy, e.g., eggs (it’s recommended that you not give egg whites to babies under 12 months). Talk to your pediatrician about your baby’s diet to see if food allergies might be a factor.

    • Your baby may be sensitive to anything that touches the skin on his neck. For example, don’t put a necklace on your baby, cut off the labels from his clothes. Dress your baby in cotton clothes (not wool), and use only cotton sheets and blankets.

    • Your baby may be sensitive to soap, lotions, and laundry detergent. Avoid soaps with perfumes and antiperspirants, and instead use Dove, Neutrogena, or a non-soap cleansing lotion such as Cetaphil. Only use lotion and laundry soap that is free of perfume.
  • Take care in bathing your baby. Since soap can irritate your baby’s skin, only bathe your baby 1-3 times a week, not every day. Since hot water can make eczema worse, only use warm water. After the bath, gently pat your baby dry since rubbing the skin can be irritating. Apply a moisturizer right after the bath—the greasier the lotion the more it protects the skin and the less it stings—try petroleum jelly (Vaseline) or Eucerin lotion.

  • When the eczema rash comes back, consult your doctor about the best treatment. Steroid creams are the most common treatment to reduce the inflammation, and there are different strengths of steroids depending on the severity of the rash. There are also new, non-steroid creams that have been successful. If your baby is scratching a lot, the doctor might recommend an antihistamine medicine at bedtime. Be sure to follow the treatment for the length of time prescoted; and keep up the prevention measures even when your baby is free of the rash.

If none of these measures work, there’s a possibility that your baby has a rash of a different cause such as seborrhea, yeast, or bacterial infection. Your pediatrician should be able to diagnose and treat the rash, or refer you to a dermatologist if necessary.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician