What is the treatment approach for pediatric eczema?

From the Guidelines

The treatment approach for pediatric eczema involves a multi-faceted strategy focusing on skin hydration, inflammation control, and trigger avoidance, as recommended by the most recent guidelines 1.

Key Components of Treatment

• Daily bathing using lukewarm water and gentle, fragrance-free cleansers, followed immediately by applying moisturizers like petroleum jelly, Cetaphil, CeraVe, or Eucerin to lock in moisture.
• For mild flares, use low-potency topical corticosteroids such as hydrocortisone 1% cream twice daily for 7-14 days.
• Moderate to severe cases may require medium-potency steroids like triamcinolone 0.1% or fluocinolone 0.025%, but limit use to 2 weeks to avoid side effects.
• Non-steroidal alternatives include tacrolimus (Protopic) 0.03% and pimecrolimus (Elidel) for sensitive areas like the face.

Additional Therapies

• Wet wrap therapy can help severe flares by applying medication, moisturizer, then damp bandages covered by dry ones for 2-8 hours.
• Identify and avoid triggers such as harsh soaps, fragrances, certain fabrics, and known allergens.
• Dress children in cotton clothing, keep fingernails short to minimize damage from scratching, and maintain optimal humidity levels at home.

Systemic Medications

• For severe cases unresponsive to topical treatments, consult a dermatologist for potential systemic medications like dupilumab for children 6 years and older, as approved in Taiwan 1. This comprehensive approach addresses both the skin barrier dysfunction and immune dysregulation that characterize eczema, and is supported by the latest research and guidelines 1.

From the FDA Drug Label

Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily children under 2 years of age: ask a doctor Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced HPA axis suppression and Cushing's syndrome than mature patients because of a larger skin surface area to body weight ratio Use of clobetasol propionate topical solution in pediatric patients under 12 years of age is not recommended.

The treatment approach for pediatric eczema involves applying topical corticosteroids, such as hydrocortisone 2 and triamcinolone 3, to the affected area. However, it is essential to follow the recommended usage and precautions, especially in children under 2 years of age, as they may be more susceptible to systemic toxicity.

• For children 2 years of age and older, apply the medication to the affected area not more than 3 to 4 times daily.
• For children under 2 years of age, consult a doctor before using any topical corticosteroids.
• Clobetasol propionate 4 is not recommended for use in pediatric patients under 12 years of age due to the risk of HPA axis suppression and Cushing's syndrome.

From the Research

Treatment Approaches for Pediatric Eczema

The treatment of pediatric eczema involves a multifaceted approach, including topical corticosteroids, emollients, and other therapies. The choice of treatment depends on the severity of the eczema and the individual child's needs.

• Topical Corticosteroids: Topical corticosteroids are a common treatment for pediatric eczema, with potent and moderate topical corticosteroids being more effective than mild topical corticosteroids for moderate or severe eczema 5. A study found that a short burst of a potent topical corticosteroid is just as effective as prolonged use of a milder preparation for controlling mild or moderate atopic eczema in children 6.
• Emollients: Emollients are effective first-line treatment to decrease symptoms of eczema and reduce the need to use steroids in children 7. They help to moisturize the skin and can be used in conjunction with topical corticosteroids.
• Combined Antibiotic/Corticosteroid Cream: A combined antibiotic/corticosteroid cream may be effective in reducing disease severity and improving quality of life in children with moderate to severe eczema, but caution is needed due to the emergence of antibiotic-resistant bacteria 8.
• Systemic Therapies: Systemic therapies, such as cyclosporine and dupilumab, may be effective in severe cases of pediatric eczema, but their use is limited by cost and availability 9.

Application and Duration of Treatment

The application and duration of treatment for pediatric eczema can vary depending on the severity of the eczema and the individual child's needs.

• Application Frequency: Applying potent topical corticosteroids once a day may be just as effective as applying them twice a day or more 5.
• Duration of Treatment: The optimal duration of treatment for pediatric eczema is not well established, but a study found that a two-week course of treatment with a combined antibiotic/corticosteroid cream was effective in reducing disease severity and improving quality of life 8.
• Proactive Therapy: Proactive therapy, such as applying topical corticosteroids on weekends, may be effective in preventing relapses of eczema 5.

Safety and Efficacy

The safety and efficacy of treatments for pediatric eczema are important considerations.

• Local Adverse Events: Local adverse events, such as skin thinning, can occur with the use of topical corticosteroids, especially with higher-potency preparations 5.
• Systemic Adverse Events: Systemic adverse events, such as increased risk of infections, can occur with the use of systemic therapies, such as cyclosporine and dupilumab 9.
• Efficacy: The efficacy of treatments for pediatric eczema can vary depending on the severity of the eczema and the individual child's needs, but topical corticosteroids and emollients are generally effective in reducing symptoms and improving quality of life 5, 7.