Skincare for Atopic Dermatitis and Sensitive Infant Skin

Myths and Facts

Up to 20% of children worldwide are affected by atopic dermatitis; however, an even larger proportion tend to exhibit sensitive, dry skin that merely requires intensified care.⁷

Persistent myths such as “moisturizing leads to increased skin dryness due to habituation” or “children with eczema should bathe as infrequently as possible” are no longer consistent with current dermatological guidelines. But how should sensitive pediatric skin be appropriately cared for? Is daily bathing fine, or should water exposure be minimized? Are natural cosmetics and home remedies beneficial, or are they contraindicated for allergy-prone skin?

It is important to note that healthy neonatal skin does not automatically require regular moisturizing; the fine lamellar desquamation observed during the first weeks of life is a physiological phenomenon.

Current evidence regarding whether consistent prophylactic moisturizing therapy can prevent the development of atopic dermatitis in high-risk infants remains inconclusive.⁸ ⁹

At birth, the delicate skin of newborns is not yet fully matured. It is well established that the natural moisturizing factors (NMF) only achieve full maturation during the first few years of life. For instance, in the cheek area, NMF maturation is not complete until approximately seven years of age.¹⁰ This explains why typical “cheek eczema” is frequently observed in infants and young children—not only in the setting of atopic dermatitis but also during infectious illnesses or teething periods.

Generally, a predisposition to eczema becomes evident from the third month of life onward. Clinically, palpable papules appear, which may be excoriated or abraded due to itching. Overall, the skin tends to exhibit dryness and roughness. 

In the acute phase, lesions may exude and form crusts. Sometimes, thick, honey-yellow crusts develop, indicating a secondary infection with Staphylococcus aureus, which necessitates targeted antiseptic or antibiotic topical therapy.¹¹ ¹²

In such cases, prompt dermatological evaluation is crucial to appropriately stage and manage the eczema, to control the progression of atopic dermatitis, and to avoid potential mistreatment.

Therapeutic bathing and basic skincare

Daily therapeutic bathing using clear water is particularly important in cases of eczema, as it helps to hydrate the skin, remove microbial load and cleanse residual ointments. The water temperature should be kept relatively cool, ideally between 32–34°C, and should not exceed 36°C. Bathing time should be kept short (personal recommendation: 8 minutes, no longer than 10 minutes). Bathing in clear water is preferable to using bath additives, due to the potential risk of allergic sensitization.

For more unclean body areas such as the gluteal region, hands, and feet, a mild, pH-neutral synthetic detergent (syndet) can be used locally, as it cleanses gently and is suitable for individuals with a predisposition to allergies.

After bathing, it is advisable to rinse the skin with lukewarm water, gently pat it dry (without rubbing or scrubbing), and apply a pure care product (referred to as basic skincare) to the entire body within two minutes.

Performing moisturizing therapy at this time allows the nourishing ingredients to be optimally absorbed, locks moisture into the skin, and reinforces the skin's protective barrier. A high moisture content in the skin allows for the coexistence of a greater variety of bacterial species. Increased microbial diversity within the skin microbiome, in turn, is beneficial for maintaining overall skin health.² ¹³

Selecting the Appropriate Basic Skincare Product

No universal recommendation can be made regarding the choice of basic skincare products, as there is now a wide range of well-tolerated formulations available.

The term “Emollient PLUS” refers to new basic skincare products that additionally contain non-pharmacologically bioactive ingredients. These include, for example, cosmetic lotions incorporating bacterial lysates, which represent “beneficial bacteria” and can help reduce excessive colonization by Staphylococcus aureus. Such products may serve as a valuable supplement to basic skincare for patients with atopic dermatitis and have been shown to reduce both the number and frequency of disease flares.¹⁴ ¹⁵

Skincare products containing ceramides (key components of the skin’s barrier function) are also associated with high patient satisfaction and excellent tolerability.¹⁶

Basic skincare should always be selected in accordance with seasonal needs—that is, using a richer formulation during the winter months and opting for lighter, fast-absorbing, non-greasy, and non-sticky textures during the summer.

Since children with atopic dermatitis and/or sensitive skin generally exhibit an increased tendency toward allergic reactions, it is crucial that skincare products are free of fragrances and potential botanical allergens.¹⁷ Although plant-based ingredients are often promoted as particularly natural and gentle, they rank among the most potent allergens¹⁸ and should therefore be strictly avoided in the management of atopic dermatitis.

As a general principle, the younger the child, the lighter the formulation should be.¹¹

Moisturization should always be perceived as a pleasant experience—this must be considered when selecting skincare products. Sticky products that require more than 10 minutes to absorb and are associated with an unpleasant odor are likely to be rejected by most patients and are not practical in clinical care.

The Coconut Oil Myth

In clinical practice, I frequently encounter families who moisturize their young children using pure coconut oil. Due to its texture, coconut oil can only form an occlusive barrier on the surface of the skin and is unable to adequately hydrate the deeper layers. The result: the skin becomes even drier. Following an explanatory conversation and a change in the skincare routine, an improvement in the child's skin condition is usually observed within a short period.

Immediate Relief for Itching

This scientific article has been authored by an expert who received compensation from MAM.

Published in June 2025.