From the Guidelines
Oral corticosteroids can be prescribed for a 1.5-year-old child with severe eczema, but they should be used cautiously and only for short periods, as recommended by the International Eczema Council 1. When considering treatment options for a pediatric patient with severe eczema, it's essential to weigh the benefits and risks of oral corticosteroids. According to the guidelines of care for the management of atopic dermatitis, systemic immunomodulatory agents, including oral corticosteroids, are indicated for patients who do not respond to optimized topical regimens and phototherapy 1.
Key Considerations
- The decision to initiate oral corticosteroids should be made after careful consideration of the potential risks and benefits, including the risk of pituitary-adrenal suppression, growth suppression, and immune system impairment.
- Prednisolone is typically the preferred option, usually dosed at 1-2 mg/kg/day for 5-7 days maximum.
- The liquid formulation is easiest to administer to young children, preferably with food to minimize stomach upset.
- Parents should be informed about potential side effects, including irritability, increased appetite, and sleep disturbances.
Long-term Management
- Long-term or frequent use of oral steroids should be avoided due to serious side effects.
- After a short course of oral steroids, it's essential to maintain good skin care with regular moisturizing and appropriate topical treatments to prevent relapse.
- If a child requires multiple courses of oral steroids, referral to a pediatric dermatologist or allergist is recommended to explore alternative treatment strategies for better long-term management, as suggested by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1.
From the FDA Drug Label
The efficacy and safety of prednisolone in the pediatric population are based on the well-established course of effect of corticosteroids which is similar in pediatric and adult populations. Prednisolone sodium phosphate oral solution is indicated in the following conditions: Allergic States: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in adult and pediatric populations with: ... atopic dermatitis;
Oral Steroids for Severe Eczema in Pediatric Patients:
- The FDA drug label for prednisolone indicates that it can be used in pediatric populations for the treatment of severe or incapacitating allergic conditions, including atopic dermatitis.
- Key Considerations:
- The efficacy and safety of prednisolone in pediatric patients are similar to those in adults.
- Pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and osteoporosis.
- Children who are treated with corticosteroids may experience a decrease in their growth velocity.
- Clinical Decision: Based on the FDA drug label, oral steroids (corticosteroids) such as prednisolone can be considered for the treatment of severe eczema (atopic dermatitis) in pediatric patients, including those aged 1.5 years. However, it is essential to carefully weigh the potential benefits against the risks, particularly the potential impact on growth velocity, and to monitor the patient closely for any adverse effects 2.
From the Research
Oral Steroids for Severe Eczema in Pediatric Patients
- The use of oral steroids for severe eczema in pediatric patients is generally discouraged, but may be considered in certain circumstances, such as a lack of other treatment options or during acute flares 3.
- Most respondents in a survey of the International Eczema Council agreed that systemic corticosteroids should never be used in children, but consensus was not reached on this statement 3.
- There is limited evidence on the use of oral steroids in pediatric patients with severe eczema, and more research is needed to determine the safety and efficacy of this treatment option.
Alternative Treatment Options
- Topical corticosteroids are a common treatment option for eczema, and may be effective for mild to moderate cases 4, 5.
- Other treatment options, such as phototherapy, antimicrobials, antihistamines, and systemic immunosuppressives, may also be considered for severe or difficult-to-treat cases 6, 7.
- Proactive therapy with twice weekly use of topical corticosteroids and calcineurin inhibitors may help to reduce the frequency of eczematous flares 7.
Considerations for Pediatric Patients
- When prescribing topical corticosteroids for use in children, lower potencies and shorter durations should be used to minimize the risk of adverse effects 5.
- The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 5.
- Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 5.