Knowing how severe your baby’s eczema is will help you get them the care they need – and help you determine their food allergy risk. How to know whether your baby’s eczema is mild, moderate, or severe? We’ve got the answers here.
If your baby has eczema (atopic dermatitis), they will have an itchy, dry rash that flares up (gets worse) when exposed to irritants or allergens. Knowing whether your baby’s eczema is mild, moderate, or severe will help you get them the care they need – and help you determine their food allergy risk.
How to determine whether your baby’s eczema is mild, moderate, or severe? We’ve got the answers here, including how doctors make this call.
Mild vs. Moderate vs. Severe Eczema
Generally, how severe a baby’s eczema is depends on how much it gets in the way of daily life.
- Mild eczema generally doesn’t interfere with a baby’s normal daily routine.
- Moderate eczema is uncomfortable enough that it gets in the way of routine activities like sleep, eating, and play, but is able to be controlled through flare management strategies. A child with moderate eczema may benefit from prescription medicine (applied on the skin).
- Severe eczema causes intense, constant itching that interferes heavily with daily life – itching that can’t be controlled through parents’ at-home flare management strategies. It usually takes prescription medicine (applied on the skin) to control severe eczema.
Why is it important to know your child’s eczema severity?
Managing your child’s eczema
Knowing how severe your child’s eczema is is an important step in managing it.
If your child has mild eczema:
- A daily bath (using lukewarm water and fragrance free cleanser) and twice-daily moisturizing should keep it under control.
If your child has moderate eczema:
- You can apply more detailed at-home flare management strategies to help them find relief, in addition to the daily bath and moisturizing routine.
- These may include using over-the-counter corticosteroids on baby’s flare spots, or starting wet wrap therapy if recommended by a doctor.
- Also, you’ll know to start taking your child to an allergist or dermatologist for help with eczema management.
If your child’s eczema is severe:
- An allergist or dermatologist can prescribe topical medicine, and give other detailed advice, that can help get your baby’s persistent and intense eczema under control.
- The same daily bath and moisturizer routine that’s recommended for babies with mild or moderate eczema is also recommended for babies with severe eczema.
Note: For all severity levels of eczema, the American Academy of Dermatology (AAD) recommends moisturizing baby twice a day using a fragrance-free moisturizer. This includes applying moisturizer right after baby’s bath. Thick creams and ointments are more effective for moisturizing.
As for baby’s daily bath, the AAD recommends that you only wash dirty or smelly areas of baby’s body, and advises parents not to scrub baby’s skin (only gently wash it). Stick to fragrance-free cleanser and lukewarm water, and limit the bath to 5-10 minutes.
Knowing your child’s food allergy risk
It’s also important to know your child’s eczema severity because of how eczema is linked to food allergies. Eczema is part of a progression called the atopic march, and is an allergic condition. According to the atopic march, children with one allergic condition are at increased risk for others, and allergic conditions often appear in a certain order.
Eczema comes before food allergies in the atopic march. This means if a baby has eczema, they are more likely to develop food allergies. In fact, babies who have eczema are at the highest risk for developing a food allergy later in life. And the more severe your baby’s eczema is, the more likely they are to develop a food allergy. Some research suggests that controlling your baby’s eczema can reduce their risk of developing allergies in the future.
According to Dr. Jonathan Spergel, Board Certified Allergist and Member of the National Eczema Association Scientific Advisory Committee, “Up to 67% of infants with severe eczema, and 25% of infants with mild eczema, will develop a food allergy.”
Due to their increased food allergy risk, it’s important to get your baby’s eczema under control so that you don't mistake eczema for hives/rashes from a food allergy.
It’s also recommended that parents use a barrier cream around their baby's mouth if they have severe eczema, to keep the food off baby’s skin. For babies with severe eczema, getting food on the skin can be irritating.
Eczema severity and early allergen introduction
Because of their increased food allergy risk, introducing common allergenic foods to eczema babies early and often is recommended for healthier outcomes.
Dietary guidelines from the U.S. Department of Agriculture (USDA) recommend the early, frequent introduction of peanut for all babies, but particularly for babies who have eczema. And the more severe baby’s eczema is, the more important it is to introduce peanut early.
The USDA’s most recent Dietary Guidelines recommend that “if an infant has severe eczema...age-appropriate, peanut containing foods should be introduced into the diet as early as age 4 to 6 months.” This introduction is especially important for babies with eczema, because of their increased food allergy risk.
Eczema scoring by doctors: Preparing for an appointment
To know for sure whether your baby’s eczema is mild, moderate, or severe, you’ll need an allergist, dermatologist, or other trained doctor to apply a scoring system.
You can prepare for this scoring by evaluating your baby at home and sharing the findings with a doctor.
Answer the questions below with one of these four answers:
Here are the questions to answer before you see a doctor:
- How much does eczema affect my baby’s daily routine?
- How inflamed is my baby’s skin? (For babies with lighter skin, look for dry red patches. For babies with darker skin, look for dry patches that are dark brown, purple, or gray.)
- How dry is my baby’s skin in the areas that aren’t inflamed?
- How much swelling and puffiness is there on my child’s skin?
- How much oozing and crusting is there?
- How much has baby been scratching – how many scratch marks are there where baby has opened the skin?
- How thickened and leathery is baby’s skin?
Eczema scoring by doctors: How it works
There are two main ways doctors score the severity of someone’s eczema. Here’s an overview of each.
The EASI Score
Doctors can use a tool called the EASI score, or Eczema Area and Severity Index, to determine whether someone’s eczema is mild, moderate or severe.
To know for sure whether your baby’s eczema is mild, moderate, or severe based on the EASI score, you’ll need an allergist, dermatologist, or other trained doctor to calculate the score.
Doctors consider the following symptoms in the EASI score:
- Inflammation: Dry skin with a color change caused by increased blood flow (This is sometimes called “redness,” but the EASI score accounts for differences in inflamed skin color based on how light or dark someone’s skin is.)
- Scratching: Signs of scratching that breaks the skin surface
- Lichenification: How much the skin thickens and becomes leathery due to irritation
These symptoms are checked across four regions of the body to determine eczema severity:
- Head and neck
- Upper limbs (arms)
- Lower limbs (legs and buttocks)
A doctor will check each of the four symptoms in all the different regions. They will score each symptom on a scale of 0 to 3, based on its severity (intensity) in that region:
- 0 = Not present
- 1 = Mild (just visible)
- 2 = Moderate (obvious)
- 3 = Severe (intense)
They will also give each region an area score between 0 and 6, based on the percentage of each region that’s affected by eczema.
- Add up the severity scores for each symptom within the region
- Multiply the total severity score by the area score for that region
- Apply a specific region multiplier for each region
- Add up the scores for all 4 regions to get the final EASI score
The final score determines how severe someone’s eczema is:
- A score of 0 means clear (no eczema)
- A score of 0.1 to 1.0 means almost clear (hardly any eczema)
- A score of 1.1 to 7 means the eczema is mild
- A score of 7.1 to 21 means the eczema is moderate
- 21.1 to 50 means the eczema is severe
- A score of higher than 51 means the eczema is very severe
The SCORAD Score
Doctors can also use a tool called the SCORAD score, or Scoring Atopic Dermatitis score, to determine whether someone’s eczema is mild, moderate or severe.
To know whether your baby’s eczema is mild, moderate, or severe using the SCORAD score, you’ll need an allergist, dermatologist, or other trained doctor to apply it.
Doctors consider the following eczema symptoms in the SCORAD score:
A doctor will check each of these six symptoms in a representative region where baby’s eczema is flaring up. They will score each symptom on a scale of 0 to 3, based on its severity (intensity):
- 0 = Not present
- 1 = Mild (just visible)
- 2 = Moderate (obvious)
- 3 = Severe (intense)
Since there are six symptoms that get checked, this means the lowest possible severity score is 0, and the highest possible severity score is 18.
The doctor will also check how much eczema is affecting the body across the following areas (regions):
- Head and neck
- Front of the trunk
The total area score can range from 0% to 100% of the body.
Finally, the doctor will ask the parent or caregiver two questions:
- Rate how much baby is itching on a scale of 0 to 10 (with 0 meaning no itchiness at all and 10 meaning the most severe itch).
- Rate how much sleeplessness the eczema is causing on a scale of 0 to 10 (with 0 meaning not causing any sleep trouble and 10 meaning the worst possible sleeplessness).
For older children and adults, the doctor will ask the person with eczema to answer these questions.
The doctor will then use a formula to calculate the final SCORAD score based on the area score, severity score, and the ratings the parent (or patient) gave.
[Total area score] / 5 + [7 times the total severity score] / 2 + [total parent rating score] = SCORAD score
- If the final score is less than 25, your baby’s eczema is mild.
- If the final score is between 25 and 50, your baby’s eczema is moderate.
- If the final score is greater than 50, your baby’s eczema is severe.
All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.
These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease.
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