Baby drool rash and atopic eczema look very similar. Learn how to tell the difference between baby drool rash and atopic eczema, so baby can receive the care they need.
Baby drool rash and atopic dermatitis (the most common type of eczema) look very similar. In fact, they’re more closely related than many people realize.
But while drool rash goes away after the proper treatment (and won’t be a problem as your little one grows out of drooling), atopic eczema is chronic and most often lifelong.
How can you tell the difference between drool rash and eczema, so your baby gets the care they need? Here’s what parents need to know.
What is baby drool rash?
Baby drool rash happens when the skin around, near, or under baby’s mouth becomes irritated by their own saliva.
When too much saliva dribbles onto these skin areas too often, and stays on these areas for too long, it irritates baby’s skin.
This causes baby to develop a rash of raised, itchy bumps around the mouth, chin, cheek, neck, and/or chest areas.
On light skin, the rash will appear red, and on darker skin, it may appear purplish-red, gray, dark brown, or slightly darker than the person’s skin.
Drool rash isn’t contagious or serious, but it can be very irritating for baby.
Why do babies develop drool rash?
Drool rash is most common in babies between three and six months of age --- about the same time they enter the teething stage. But it could develop anytime after baby hits the two-month mark --- the earliest that their salivary glands could start producing --- and anytime before baby reaches their second birthday.
Since baby doesn’t have full control over the muscles that help them swallow food and saliva (and won’t until about 18 months-2 years of age), the drool dribbles down their mouth instead.
Drooling is perfectly normal --- once it starts, that’s a sign that baby is developing food-related fine motor skills like chewing. And when baby starts eating solid foods, they’ll drool even more as their body produces the saliva needed for digestion. Too much drooling that isn’t cleaned off of baby’s face, though, could lead to drool rash.
What is atopic eczema (atopic dermatitis)?
Atopic eczema, or atopic dermatitis, is a chronic skin condition that is usually lifelong. It causes someone’s skin to develop itchy and dry patches. Sometimes, these patches are rough and itchy, and other times, these patches are crusty and bumpy areas that may leak fluid.
On people with lighter skin, these patches are almost always red. On people with darker skin, the patches may appear darker brown, purplish-red, gray, or slightly darker than the person’s normal skin color.
Eczema can appear anywhere on the body. But most commonly, it affects the elbows, knees, arm joints, leg joints, other skin creases, cheeks, forehead, and scalp.
Why do babies develop atopic eczema?
While we don’t yet know what causes atopic eczema, we do know that it’s a condition that’s related to food allergies. Both atopic eczema and food allergies are known as “allergic conditions,” and someone who develops atopic eczema is more likely to develop a food allergy later.
We also know that atopic eczema flares up, or gets worse, when someone’s skin is exposed to certain triggers. The triggers that cause flare-ups are different for every person with atopic eczema. But they can include irritants like dyes, fragrances, detergents, soaps, certain fabrics, chemicals, and metals. Other atopic eczema triggers include food allergens or environmental allergens (when someone has an existing allergy), dry skin, dry air, heat, and existing skin infections.
Drool rash vs. baby eczema: How are they related?
Many people don’t realize that drool rash is actually a type of eczema (or dermatitis). “Eczema” and “dermatitis” are catch-all terms for several different types of skin conditions. All types of eczema cause inflammation and irritation of the skin.
One type of eczema is atopic dermatitis (atopic eczema) --- the most common type of eczema that we covered above.
Another type of eczema is contact dermatitis. Contact dermatitis flares up and causes a rash when someone’s skin comes in direct contact with an irritant. Drool rash is a type of contact dermatitis --- in this case, baby’s own saliva is the irritant that causes the rash.
Both contact dermatitis (including drool rash) and atopic dermatitis can flare up when someone’s skin is exposed to certain irritants. But atopic dermatitis can sometimes be triggered by allergens, heat, dryness, and infections as well.
Drool rash vs. atopic eczema: How to tell the difference?
But how to tell the difference between atopic dermatitis and drool rash? The main difference is where the rash appears.
Drool rash usually only appears around and directly below the mouth. It will appear around the mouth, chin, and neck, and may also appear on the chest if the drool gets that far. But it won’t appear any lower on the body, or above the nose.
Meanwhile, atopic eczema often appears on the elbows, knees, arm joints, leg joints, forehead and scalp. Drool rash won’t appear in these places, because they’re too low or too high for the drool to affect.
Drool rash vs. perioral contact dermatitis
Another type of baby rash is perioral contact dermatitis (perioral food rash), which appears around the mouth and often looks like acne or hives. This rash happens when acidic fruits or vegetables – like oranges, tomatoes, and strawberries – irritate the skin around the mouth.
If drool causes the food to stay around the mouth for long periods, drool can lead to a perioral food rash. But drool isn't the direct cause of a perioral food rash – the acidic food is. And food could irritate the skin because of other reasons. For instance, food might get smeared around the mouth and linger there for a while, or pacifier use might irritate the skin and lead to a perioral food rash that lasts longer.
A perioral contact dermatitis rash may look like hives, but it does not mean that your child is allergic to the food that caused it. This rash is completely harmless, and baby doesn’t need to completely avoid the food that caused the rash. It is also different from eczema (atopic dermatitis).
How to manage drool rash?
The best way to keep drool rash from developing --- or getting worse --- is to clean the drool off of baby’s skin regularly. Keep a burp cloth nearby to gently wipe off drool, especially after feeding baby. Have baby wear a bib to catch drool so it doesn’t get on their chest, and change their clothes if drool makes their chest area too wet.
If baby develops a drool rash, a washing routine will help relieve it.
Clean off their affected areas twice a day by wetting a cloth with warm water and gently washing the area. Make sure you don’t rub the area, as rubbing will irritate the skin more. Then, gently pat the area dry (again, don’t rub it). Make sure that you completely dry the area.
Also, apply a baby-safe ointment or face cream to the affected areas, to create a barrier that protects the skin from saliva. Don’t use a lotion, as that could be irritating.
When you bathe baby, stay away from soaps. Use a mild, unscented baby cleanser instead.
Avoid using other harsh, irritating substances on baby’s skin and clothes, as irritants could worsen the rash if they come in contact with it. Use laundry detergents that don’t contain fragrances or dyes, stay away from soaps, and steer clear of scented lotions.
And make sure that you keep the rash-affected area as dry as possible.
Should you visit the doctor for baby’s drool rash?
With at-home treatments like the ones we described above, drool rash will usually go away in about a week. But if baby’s drool rash looks blistery, oozy, or crusty, this may be a sign of infection, so baby needs medical attention. If the rash doesn’t improve after several days of treatment, seems excessively itchy, or baby seems to be in pain because of the rash, you should also see your pediatrician. The pediatrician may prescribe a cream, ointment, or other topical treatment to help baby’s rash heal.
How to manage atopic eczema?
Bathing baby and moisturizing their skin regularly are key to treating atopic eczema. This is because babies with this eczema are prone to skin dryness --- moisture easily escapes their compromised skin barrier.
Bathe baby in lukewarm water daily. Use a fragrance-free cleanser, and gently wash them, then pat baby dry. Follow up the bath by moisturizing baby’s skin liberally within three minutes, to seal the moisture into baby’s skin.
Beyond the bath, intentionally moisturize baby’s skin several times a day by spritzing it with water, then applying moisturizer. And be sure to avoid exposing baby to their eczema triggers and irritants!
For more details on bathing eczema babies, choosing the right moisturizer, and effective atopic eczema care, please read our linked articles.
Should you visit the doctor for baby’s atopic eczema?
Since atopic eczema is a chronic, usually lifelong condition, you should start to take baby to a dermatologist if you haven’t already. The dermatologist will help you manage baby’s eczema effectively, and may prescribe helpful topical steroid treatments if the eczema is severe.
Drool rash vs. eczema vs. other rashes
The table below breaks down the difference between drool rash, eczema, and other rashes:
|
Cause |
Appearance |
Itchy? |
Raised? |
Other symptoms? |
Where does it appear? |
|
|
Drool Rash |
Irritation from drool |
Raised bumps |
Yes |
Yes |
No |
Around the mouth, chin, cheek, neck, and/or chest |
|
Eczema |
Unknown, but irritants/ allergens cause flare-ups |
Dry, scaly, crusty, inflamed patches |
Usually |
No |
No |
Usually forehead, cheeks, scalp, knees, elbows, joints |
|
Perioral contact dermatitis |
Contact with acidic food at mouth |
Spotty, acne-like, inflamed |
Sometimes |
Usually |
No |
Around mouth, chin, and neck |
|
(Other) contact dermatitis |
Skin contact with irritants/ allergens |
Bumps or inflammation in one area |
Usually |
Usually |
No |
Anywhere that contacts a “trigger” |
|
Food allergy rash |
Immune system reaction |
Hives (inflamed, raised bumps) |
Yes |
Yes |
Yes |
Could appear anywhere |
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These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease. If your infant has severe eczema, check with your infant’s healthcare provider before feeding foods containing ground peanuts.