What is the difference between eczema in babies and atopic dermatitis?

Eczema and Atopic Dermatitis Are the Same Condition

There is no difference between eczema in babies and atopic dermatitis—these terms refer to the same chronic inflammatory skin disease. 1, 2 The term "eczema" is simply the common name for atopic dermatitis, and "infantile eczema" specifically describes atopic dermatitis occurring in infants. 3

Terminology Clarification

• Atopic dermatitis is also known as atopic eczema or infantile eczema in infants, representing identical conditions with different naming conventions used interchangeably in clinical practice. 1, 2
• The medical literature and clinical guidelines consistently use these terms synonymously, with no distinction in diagnostic criteria, pathophysiology, or treatment approaches. 1

Diagnostic Criteria for Atopic Dermatitis/Eczema in Babies

All three of the following must be present for diagnosis:

1. Pruritus (itching) - This is mandatory at any age, though in infants it manifests as scratching or rubbing behavior. 1, 4

2. Eczematous lesions with age-specific distribution pattern:

   • In infancy, the condition classically starts on the cheeks and extends to the neck, trunk, and extensor surfaces of extremities. 1, 4
   • Notably spares the diaper area, which is a key distinguishing feature from other conditions. 1, 4
   • Acute lesions present as erythema, exudation, papules, and vesiculopapules. 1, 4

3. Chronic or relapsing course:

   • Duration greater than 2 months for infants less than 12 months of age. 1
   • Duration greater than 6 months for children and adolescents. 1

Key Distinguishing Features from Other Conditions

Differentiating from Seborrheic Dermatitis

This is the most important differential diagnosis in infancy, as the two conditions can overlap and be difficult to separate. 4, 5

• Seborrheic dermatitis lacks pruritus, while itching is mandatory for atopic dermatitis. 4
• Seborrheic dermatitis presents with greasy, yellow scales rather than the red, scaly, weepy lesions of atopic dermatitis. 4
• Seborrheic dermatitis affects the groin and axillary regions, while atopic dermatitis spares these areas. 4

Clinical Presentation Details

• General dry skin (xerosis) is characteristic and progresses to inflammatory conditions including fissures. 6
• The condition commonly affects flexural areas where chronic rubbing leads to lichenification in older children. 6
• Atopic dermatitis in early childhood is often accompanied by development of other allergic diseases such as asthma and allergic rhinitis in the "atopic march." 1

Pathophysiology

The condition results from complex interactions between:

• Skin barrier dysfunction - Critical to initiation and exacerbation, involving both genetic factors (such as filaggrin gene mutations) and environmental disruption. 1, 7
• Immune dysregulation - Significant activation of T-helper 2 cells with increased expression of IL-4, IL-5, IL-13, and IL-31. 1
• Genetic predisposition - Family history of atopy is a significant risk factor. 1, 7

Common Pitfall to Avoid

Do not assume that different terms indicate different conditions. Whether a parent reports their baby has "eczema," "infantile eczema," or receives a diagnosis of "atopic dermatitis," these all refer to the same disease entity requiring identical diagnostic and management approaches. 1, 3, 2 The terminology variation reflects historical naming conventions and regional preferences rather than distinct clinical entities.