Managing Postpartum Eczema: A Guide

Nothing compares to the joy of holding your newborn child after waiting to meet them for nine months. Soon, though, nighttime feedings, crying spells, and dirty diapers demand a new mother’s attention. This makes the postpartum period a uniquely stressful time. 

Some mothers must deal with postpartum eczema on top of this stress. Read on to learn how postpartum eczema develops and how it can be prevented and treated. 

 

What causes postpartum eczema? 

 

Within the first 48 hours after birth, a mother’s hormones begin to fluctuate dramatically. Estrogen levels plummet, as does progesterone. This sets off changes to the skin and the immune system. Add to it the stress inherent in caring for a newborn, and you have a perfect storm. 

 

 

 

 

 

Hormonal changes

 

Hormone fluctuation in pregnancy undeniably affects the skin, and the shift in hormones after the birth do, as well. The hormones most directly implicated in eczema flares are estrogen and progesterone. 

 

Estrogen

 

 

Estrogen plays many critical roles during pregnancy. In the very early stages of the pregnancy, it is vital in preventing ovulation and shedding of the uterine lining. 

As the pregnancy progresses, estrogen levels rise, stimulating placental development and facilitating blood flow to the uterus and placenta. It also triggers the development of organs and endocrine glands for the fetus.

In late pregnancy, estrogen promotes the growth of breast tissue and milk ducts. Estrogen levels peak in the third trimester, when it ripens the cervix and triggers prostaglandin production in preparation for delivery. 

Estrogen stimulates the production of collagen and elastin, as well as hyaluronic acid, all of which are integral to the skin’s barrier function. Elevated levels of this hormone are responsible for the so-called “glow of pregnancy.” 

The delivery of the placenta (afterbirth) in the third stage of labor causes a sharp dip in estrogen levels. As estrogen levels fall, so too does the production of collagen and elastin. The skin becomes dryer. The skin barrier becomes more fragile. As a result, the skin becomes more easily irritated, and the risk of eczema flares increases. 

Progesterone

 

Like estrogen, progesterone levels increase throughout pregnancy: At full term, a mother’s progesterone levels hover somewhere between 100 and 200 nanograms per milliliter. To put that into perspective, pre-pregnancy levels of progesterone range from  0.1 to 25 nanograms per milliliter!

In early pregnancy, rising progesterone levels work alongside estrogen to prevent the shedding of the uterine lining. It also suppresses the innate immune system to prevent rejection of the developing fetus. Progesterone stimulates the production of sebum (oil), which helps protect the skin from moisture loss. 

Like estrogen, progesterone levels crash after birth. The production of sebum slows, which can result in reduced barrier function and dry skin. Additionally, inflammatory immune responses are no longer dampened. Irritation of compromised skin cells can trigger cytokine production, mast cell degranulation, and T-cell activation. The result is the inflammation we recognize as eczema.

 

Stress

 

Recovering from childbirth is stressful in itself. On top of this, mothers must also wake every 2-3 hours to feed and diaper a newborn. Unfortunately, stress is a major trigger for eczema. While stress cannot be completely eradicated from postpartum life, there are some practices to reduce stress and mitigate its effects: 

1. Be patient with yourself. Romanticized notions of motherhood abound–yet for all its rewards, the realities of parenting are far grittier than those ideals. Be gentle with yourself as you recover from childbirth and get to know your newborn.
2. Ask for help. We are social creatures by nature, and for most of human history, parenthood has been supported by robust social scaffolding. Don’t be afraid to ask friends and family for a hand.

 

 

 

If you cannot turn to family or friends for assistance, consider hiring a postpartum doula.

Doulas help mothers with resting and eating adequately. Consider using a cleaning or laundry service to take some weight off of mom’s shoulders. 

1. Let it go. Dishes may be waiting in the sink; takeout may have replaced the home-cooked meals you once lovingly prepared. That’s OK! Prioritize caring for yourself and your new baby during this special time. 
2. Talk to someone. Reach out to your good friends for a friendly chat or to vent. Therapists aren’t replacements for friends, but they can help you reflect upon and manage your stress. Even “confiding” in a journal can help reduce stress.

 

 

Frequent washing 

 

Baby baths and frequent hand washing take a toll on our skin. Prevent dryness by using gentle hand soaps and dish detergents. Moisturize with lotions after each wash; if you have active eczema lesions on your hands, use a healing ointment to protect them. 

Nipple eczema and breastfeeding 

 

Eczema on the nipples is painful. It can complicate breastfeeding and leaves many new mothers feeling self-conscious or awkward in their postpartum bodies. 

Topical corticosteroids and calcineurin inhibitors are both safe during breastfeeding; time application between feedings.

Clothing should be loose and soft, and it should also wick away moisture–no scratchy fabrics like wool. If you use breast pads, change them frequently.

Prevent nipple eczema by cleaning nipples with clear water after breastfeeding. Afterwards, apply an occlusive moisturizer such as hypoallergenic lanolin. Consider using a nipple shield during feedings to lessen irritation. 

Eczema on the nipples needn’t put an end to breastfeeding. Reach out to an international board-certified lactation consultant or your OB-Gyn for guidance. 

 

 

How long does postpartum eczema last?

 

Postpartum eczema usually resolves itself as hormone levels stabilize, which takes place gradually over several months.With a doctor’s guidance and sound self-care, you can safely relieve eczema symptoms and prevent flares from worsening.

Does postpartum eczema mean my baby is at greater risk for dermatitis? 

 

Eczema is not communicable, and breastfeeding cannot trigger dermatitis in your child. 

Eczema often has a genetic component, though. Babies who have a parent with an atopic disorder–atopic dermatitis, asthma, and hayfever, for example–have a 1 in 4 chance of developing eczema themselves. Having two family members with one of these disorders raises the risk to 1 in 2.

Tell your baby’s pediatrician about any new rashes. If eczema does develop, follow the doctor’s treatment plan. Moisturize affected skin with a heavier moisturizer cream, hypoallergenic lanolin, or petroleum jelly. 

 

Self-care tips for preventing and managing postpartum eczema

 

You can’t cure eczema, and you can’t prevent it 100% of the time. With some basic self-care, though, you can lower the risk of flares and heal from flares more quickly. 

 

Moisturize

 

Eczema flares signify damage to your skin barrier. This means that it needs your help to rehydrate and lock in moisture.

Choose a gentle, fragrance and dye-free moisturizer like CeraVeⓇ. Your moisturizer should contain humectants (hyaluronic acid, for example) that draw moisture in from the environment. It should also contain an occlusive like petroleum jelly or hypoallergenic lanolin to lock moisture in.  

Moisturize at least twice daily. Apply moisturizer after each facial cleansing or shower. 

Avoid scratching

 

Scratching at dry, itchy skin creates an endless itch-scratch cycle. Scratching can also cause infection. 

To relieve itching, eliminate harsh cleaning chemicals, as well as laundry detergents containing fragrances and dyes. Avoid known eczema triggers and watch for new ones. 

A cool compress can sometimes relieve itching. To make your own, soak a washcloth in cool water, wring it out, and apply it to the rash for a few minutes. This can be repeated throughout the day. 

Visit a board-certified dermatologist for effective treatment of the rash. Be sure to inform them if you are breastfeeding so they can adjust treatment accordingly. 

SmartLotionⓇ; a new mother’s friend

 

SmartLotionⓇ is an eczema cream created by Dr. Steve Harlan, a board-certified dermatologist. It is formulated for maximum effectiveness and safety, using a unique, prebiotic formula to promote the skin’s barrier function. A small amount of hydrocortisone reduces inflammation. 

Unlike most corticosteroid creams, SmartLotionⓇ can be used long-term with no risk of topical steroid withdrawal or skin atrophy. In fact, it has very few documented adverse effects at all. This makes it an ideal treatment for postpartum eczema, which may flare off and on for several months.

Under your doctor’s supervision, SmartLotionⓇ can even be used alongside most prescription eczema treatments. 

Your baby’s brief time as a newborn is both beautiful and stressful. Don’t let postpartum eczema prevent you from enjoying this moment in your child’s life. 

 

 

 

  Cee Van

  Medical Writer

  HarlanMD.com