My baby has bad nappy rash despite regular changing and the use of a barrier cream. Could she have a form of eczema?

There are actually three types of eczema that can affect the nappy
area. The most common is irritant eczema (nappy rash), which can
affect nearly all babies to some extent. This simply reflects the fact
that urine and faeces are irritant to the skin if left in contact with
it for prolonged periods. This type of nappy rash usually spares the
skin right in the groins. The skin fold between the leg and the
tummy therefore looks normal but is surrounded on either side by
red, inflamed skin.
As you are already doing all the right things to prevent nappy
rash, your baby may have one of the other types of eczema (atopicor seborrhoeic). Both of these tend to involve rather than spare
the skin fold at the top of the leg. Atopic eczema only rarely affects
the nappy area and is normally very itchy. You may see eczema in
the skin folds elsewhere on the body (e.g. in front of the elbows
or behind the knees). In contrast, seborrhoeic eczema tends not
to be itchy and tends to be associated with greasy yellow scales
on the scalp (cradle cap).
I am 45 and have never had any problems with my skin. I
now have itchy, round, scaly patches on my arms and legs
that my GP says are eczema. Is this right?
Yes, these could be, although your GP may also have considered
other causes such as fungal infection and psoriasis. This pattern
is called discoid eczema. The precise cause of this has yet to be
identified, but chronic stress and local infection may play a part.
As you have found, the rash typically presents on the limbs in
people in their forties and fifties, and it is more common in men.
Unlike atopic eczema, it favours the extensor surfaces and appears
as round ‘plaques’ rather than being more spread out. These plaques
are usually 5 cm or less in diameter. Looking closely at them, you
should see some tiny little blisters and crusting where the fluid
from the blisters has dried. The underlying skin will probably be
thickened. Discoid eczema can be very stubborn and difficult to
treat, so it may persist for many months.I had eczema as a child, but it cleared up until recently
when I got it again on my hands. Why is this?
It sounds as though you have a form of eczema caused by contact
with irritant chemicals. Not surprisingly, this is called ‘irritant
contact eczema’, and it is the most common form caused by contact
(perhaps 80% of cases), the other cause being allergic. Strong
irritants will cause an obvious and acute reaction on anybody’s
skin, but weaker irritants need months or years of exposure to
cause the same problems. As you have found, the eczema usually
affects the hands and forearms as the most common parts of the
body exposed to detergents, industrial oils, solvents, etc. Manypeople with dry or fair skin are likely to develop irritant problems,
but your history of atopic eczema doubles the risk.