From the Guidelines
The first line treatment for pediatric eczema consists of gentle skin care and topical corticosteroids, as recommended by the most recent guidelines 1.
Key Components of Treatment
- Daily bathing using lukewarm water and mild, fragrance-free cleansers
- Immediate application of moisturizers (within 3 minutes) to lock in hydration
- Use of thick emollients like petroleum jelly, Cerave, Vanicream, or Eucerin at least twice daily
- Application of low to mid-potency topical corticosteroids for active flares, such as hydrocortisone 1-2.5% for the face and intertriginous areas, or triamcinolone 0.1% for the body, twice daily for 7-14 days until the rash improves
Additional Considerations
- Avoid high-potency steroids in children unless directed by a specialist
- Wet wrap therapy can be helpful for severe flares, involving applying medication, moisturizer, then damp gauze or clothing covered by dry clothing for 2-6 hours
- Trigger avoidance is essential, with common triggers including harsh soaps, fragrances, rough fabrics, excessive heat, and certain foods The treatment regimen is based on the fundamental pathophysiology of eczema, which involves skin barrier dysfunction and immune dysregulation, and is supported by the most recent and highest quality study 1.
From the Research
First Line Treatment for Pediatric Eczema
- The first line treatment for pediatric eczema includes topical corticosteroids, as stated in the study 2 published in 1988, which emphasizes their essential role in treating children with atopic eczema.
- Emollients are also considered a crucial part of the treatment regimen, as mentioned in the study 3 published in 2002, which highlights their importance as a preventive background therapy in all stages of eczema.
- The study 4 published in 2021 recommends irritant avoidance and liberal emollient usage as the cornerstone of treatment in all age groups, with topical corticosteroids as first-line medication-based therapy in infants <2 years.
Treatment Options
- Topical calcineurin inhibitors, such as pimecrolimus, may be used in infants as young as 3 months, as mentioned in the study 4.
- In children and adolescents >2 years, topical corticosteroids are still considered first-line therapies, but topical calcineurin inhibitors and topical PDE4 inhibitors can also be used, as stated in the study 4.
- Oral systemic immunosuppressants can be used in children ages 2-12 years whose atopic dermatitis fails to respond to prior treatments, as mentioned in the study 4.
- The biologic, dupilumab, is an additional therapeutic option for adolescents >12 years, as stated in the study 4.
Application of Emollients and Topical Corticosteroids
- The study 5 published in 2016 found that the order of application of emollient and topical corticosteroids does not make a difference in the severity of atopic eczema in children.
- Parents can apply topical medications in whichever order they prefer, as there was no difference in adverse events between the groups, as mentioned in the study 5.