Eczema Facts

4-part series on What Causes Your Child’s Eczema – Staph

Eczema on neck – Bacteria colonization?

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and other research papers published online and hopefully digested the information accurately for you to read.

What is Staph?

Staph is short for staphylococcus aureus, a very resilient bacteria found on the skin that can cause infection if it penetrates the skin. More than 90% of the people with eczema has staph versus less than 10% of people without eczema. Read more about staph bacteria on eczema skin in this interview with Dr Clay Cockerell, former president of American Academy of Dermatology.

One more reason not to scratch

Scratching gives a feel-good feeling to your child as written in this post, but it’s really bad. Scratching damages the skin barrier and makes it very easy for staph to penetrate. As written in the article “Features of childhood atopic dermatitis”, staph increases IgE production, activate native T-cells by its superantigens and damage skin by its proteases.

IgE are antibodies that catalyzed the protective cells of the immune system to lock on to the antigen, see this post on immune system). Superantigens are toxins released by staph, that causes skin inflammation. Staph also results in less protein that is used to fight infection.

How do you know if your child has Staph?

Children with eczema are prone to staph bacteria, so chances are very likely there is staph on the skin but it may or may not be visible in the form of skin inflammation. If there is honey-colored crusts, pus-filled blisters, red scaly patches, swelling that is warm to the touch or fever, it’s likely that staph has already caused skin infection.

So, how to get rid of the Staph bacteria?

Marcie’s doctor Prof Hugo Van Bever recommended using chlorhexidine before applying steroid cream for Marcie. I told him during the consultation that I only use chlorhexidine (antiseptic solution) when Marcie’s rashes is persistent and red (like in the picture). However, he said that the bacteria is not visible to human eye thus it’s a good practice to clean the skin before applying steroid.

I also read that some paediatrician recommended diluted bleach bath as the bleach can remove the bacteria from the skin. Prof Hugo recommended swimming for Marcie. The idea is that people with eczema typically suffers from bacteria colonization, so remove the bacteria first and if need be, apply steroid which is more effective without the bacteria (of course, moisturizing is a must).

For previous posts in this series, see

Defective Skin Barrier



Update 2018: New antiseptic wash products such as Octenisan are now in the market, providing a more moisturizing wash option compared to chlorhexidine gluconate (which is drying).

14 replies on “4-part series on What Causes Your Child’s Eczema – Staph”

Hi Mei

Thanks for your reply on the steroid level and allergies. I just to see the pd a second time and apparently she says since my son rashes is only at his neck area so it should not be due to food or other allergies. She said his skin is too sensitive and the only way is to take very special care of his neck and keep it dry. I find that it sometimes spread to his face as he recently likes to “eat” his fist, then rubbing the fist with saliva all over his face haha.

I am very concerned on the use of steroids and hope to avoid as much as I can. I find that his eczema seems to get better with use of physiogel. But once it recovered,it seems to get attacked by patches of red sticky rashes which looked like fungus.i jus hoping he can outgrown soon and I’ll really have to try all ways to keep his neck dry.

Any other tips u can offer? 😉

Hi Aimei!
Good to know that your son’s eczema is localized.. ie at one area. I’m thinking you can apply moisturizer on his neck so that will be an additional layer to keep the irritant (saliva, food etc) away from the skin layers. Also don’t use baby wipes on his face. You can read this article for more on baby wipes!

A video by American Academy of Dermatology on face washing and my interview with a board certified dermatologist on the video may give some insight too

Take care!

Hi Mei!

I find that taking good care of his neck and keeping it dry does help and so far I’ve been applying physiogel lotion and no flare up. But his skin still appears red. Should I get a cream which is thicker as I’ve read creams is better than lotion. Reading so many sharings from others thru the forums makes me confused which to try and usually the creams comes in big bottles which would be a waste if he is not suitable.

Just to share, when his skin was a letter better though still a bit red, I took my friend advice and applied vco mixed with a little lavender essential oil which works on her son. Never did I expect it causes a flare up and I had to apply steroid for 3 times to control it. 🙁

I’m hope to find some suitable creams for maintenance now. Should I continue the lotion or change to cream? Do i need to apply on his whole body or just the affected area?

Do you have any recommendation on the laundry detergent suitable for baby with eczema? I’m using kodomo laundry detergent now.

Hi Aimei!
Sorry to hear of the flareup with vco + lavendar. Generally vco is good but there’s different quality control involved. Also something natural doesn’t mean it’s good or will not cause reaction, but there’re indeed many natural ingredients that are good but I’m also wondering if the way they are processed makes a difference. More at links below: > lavendar is anti-inflammatory

Creams are thicker, so last longer but not necessary better than lotion. Good or not depends on whether your child likes it, within budget, no flare-up after use, whether it is absorbed well and helps with the skin structure.

Moisturizing is got the whole body, if your child’s skin is dry. But if yours is only localized and no flareup anywhere else, then maybe no need. Generally for a child with eczema that get flareup at various parts of body, it is to moisturize whole body.

On detergent, can use hypoallergenic one or just wash twice, more at

You can type key words in the search box on my blog top right 🙂 Think will be helpful and help give you some answers!

Take care!

Hi Mei

Just to confirm, moisturizing is a must? I was just wondering, after applying twice steroid and the inflamed skin is better, ie no more wet and sticky but becomes dry with peeling skin, I applied moisturizer and now skin is no longer dry but still red. How to return it to normal again?

My mum was suggesting applying those baby powder after bath to keep it dry but I told her not for eczema. Am I right? Cos I recall when young we used to apply powder after a bath.

Moisturizing is a must – keep doing it even when there’s nothing wrong with the skin. I’m not sure about the redness.. it should mean that it’s still inflamed – best to check with doc the potency and duration of how long you can apply the steroid because the neck’s skin is thinner. Baby powder has no use for the skin, perhaps just to fill better but of no use. Prickly heat powder is drying, not to use. Take care!

Hi Mei

Thanks for your reply. My son’s neck flares up again for the third time with red patches. It always start off with red spots then it sort of like combine to form one big patch.

I am going back to pd again but worried that she will jus ask me to apply steroid cream. Can u give me the link on the potency of steroid creams? I can’t seem to find it.

Can my son apply patch test since he is only 4 months? Any side effects? I feel so lost as to the breastmilk I pumped but not knowing should give him or not. Breastfeeding has not been easy for me and now that my supply kind of stabilize though not enough to feed him exclusively, I hope not to give up cos of his skin problem. If I were to start on an elimination diet, what should I start with?

Hi Aimei,
Hugs! The potency of the steroid cream here
More on steroids here

Yes, my daughter took a skin prick test at 7 months, can take from 6 months. Why not book an appointment first? It may take 2-3 weeks to get an appointment, by then, close to 6 months old already. Technically, the test can be taken at very young age, just that the earlier, the less accurate cos immune system still developing. More on the skin prick test, it’s really not scary! No side effect to the test.

It’s very difficult to eliminate without knowing what items.. even peanuts, it’s like at first experts say avoid, then experts say eat more of it early, now experts just say eat whatever you like as long as it’s balanced.


Hi. My baby is 4.5 months old. One day around 3 month plus, he had this which looked like the staph bacteria in your post. After applying Kodomo lotion, it worsen and whole neck becomes red with patches. Pd said it was fungal infection. After applying anti fungal cream, it dried out and still red. Saw pd second time and they said it has developed into eczema. he was on steroid 0.05 and after few days recovered. Skin back to normal. It was cny period then.

However after about 4 days it came back. Symptoms repeated and I went thru and same application on him again. Anti fungal then steroid. Pd did mention the first time to go back after he recovered and she would recommend a suitable wash. But we didn’t.

After second outbreak, we took great care in keeping his neck dry cos earlier, we realized his saliva was dripping on his neck and chin. We wanted to see if it was the saliva causing it or other factors.

To my dismay, it came back after two days. This time round we were quite sure his neck was kept dry. I am suspecting my bm now. He was on mixed feeding, about 1/3 bm 2/3 fm. Starting today I stopped bm for time being. He has also been bathe only on water, no soap at all.

Please advise what can I do? I read that usual allergies are soy wheat egg peanuts. Should I eliminate all these in my diet? I am using physiogel now and see if it gets better before I go to the pd.

We have no family history of eczema. My elder boy was ok, even though he has been on fm. Only one month of partial bm. However this younger boy seems to have more problems. Was it cos I had taken antibiotics while breastfeeding cos I was sick?

Was it cos my bm is of low quality? Was it because at 2 months cos I took out the plaster of his injection late, he developed a rash at plaster area and was few days of antibiotics. Or was it cos he has hfmd at 2 months because of the elder brother who passed it to him?

Sorry for so many questions. I know u may not be able to answer all that’s fine. Hope I can hear from you soon.

Hi Aimei,

No worries with the string of questions. Will try my best to answer:
1. Don’t use kodomo – have to use a ‘skin’ brand like QV, physiogel etc. Check that it has no fragrance, and the shorter the ingredient list, the better. Less chance to be sensitive to the ingredients.
2. Sometimes it is trial and error as to whether a rash has a fungal/bacterial component. You may want to consult a child skin specialist and conduct an allergy test (can do at 6 months, technically even early age). If you’re seeing a GP or a PD that doesn’t stock low potency cream, they may end up prescribing creams of high potency. (pls click on the relevant tags on my blog to double-check potency and how much to use).
3. You can check on a chlorhexidine-based wash or just buy chlorhexidine and use it to wipe the skin before applying cream. The bacteria on skin creates inflammatory toxins which make the rash harder to recover.
4. Don’t worry about the diet or start questioning yourself – I suggest go for allergy testing at children clinics in hospitals. Normal GP don’t do allergy testing. I went through that phase of worrying and questioning my milk or the formula but it turned out is no allergy involved. Start reserving an appointment date to save yourself the worrying and (self-doubting) times. Hugs!
Take care,

Hi, are you using the Chlorhexidine Gluconate 0.05% (pink)? May I know how you use it? My boy has a similar red patch over his neck, just as what Marcie had on above pics..

I use the blue one, picture posted on twitter here.

I soak the cotton pad in the solution, gently squeeze it (so that it’s not dripping wet), and then wipe over my child’s skin. After like 5 minutes or so, I moisturize.

Take care, have a good week,

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