What is the approach to managing eczema in a child?

From the Guidelines

Managing childhood eczema requires a comprehensive approach focusing on skin hydration, trigger avoidance, and inflammation control, as outlined in the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1. The approach should start with daily bathing using lukewarm water and gentle, fragrance-free cleansers, followed immediately by applying a thick moisturizer like petroleum jelly, Cetaphil, CeraVe, or Eucerin to lock in moisture.

• For mild flares, use over-the-counter 1% hydrocortisone cream twice daily for up to 7 days.
• More severe cases may require prescription-strength topical corticosteroids (such as triamcinolone 0.1% or fluocinolone 0.025%) for short courses, or non-steroidal alternatives like tacrolimus (Protopic) or pimecrolimus (Elidel) for sensitive areas like the face. Some key considerations include:
• Identifying and avoiding triggers including harsh soaps, fragrances, certain fabrics (wool, polyester), dust mites, pet dander, and food allergens.
• Dressing the child in loose-fitting, cotton clothing and keeping fingernails short to minimize damage from scratching.
• Using antihistamines like diphenhydramine (Benadryl) or cetirizine (Zyrtec) to help manage nighttime itching, as suggested by various studies 1. The stepwise treatment algorithm proposed by the Taiwan guidelines 1 provides a concise overview of the management of pediatric atopic dermatitis, and should be followed to ensure a rational, cost-effective, and evidence-based management strategy. Additional measures such as wet wrap therapy, psycho-behavioral therapy, and consideration of antibiotics in cases of bacterial infection may also be necessary in certain cases, as noted in the guidelines 1. Overall, the management of childhood eczema requires a multi-faceted approach that takes into account the individual child's needs and circumstances, and should be guided by the most recent and highest quality evidence available 1.

From the FDA Drug Label

ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). ELIDEL Cream is for adults and children age 2 years and older who do not have a weakened immune system. Use ELIDEL Cream only on areas of your skin that have eczema. Use ELIDEL Cream for short periods, and if needed, treatment may be repeated with breaks in between. Stop ELIDEL Cream when the signs and symptoms of eczema, such as itching, rash, and redness go away, or as directed by your doctor

The approach to managing eczema in a child involves using ELIDEL Cream as prescribed by a doctor, only on areas of skin that have eczema, and for short periods. It is essential to follow the doctor's advice and stop the treatment when the symptoms go away. Additionally, children under 2 years old should not use ELIDEL Cream 2.

Key points to consider:

• Use ELIDEL Cream as directed by the doctor
• Apply a thin layer of ELIDEL Cream only to the affected skin areas, twice a day
• Use the smallest amount of ELIDEL Cream needed to control the signs and symptoms of eczema
• Avoid using sun lamps, tanning beds, or getting treatment with ultraviolet light therapy during treatment with ELIDEL Cream
• Limit sun exposure during treatment with ELIDEL Cream even when the medicine is not on the skin 2.

It is crucial to consult a doctor for specific guidance on managing eczema in a child, as the approach may vary depending on the individual case 2.

From the Research

Approach to Eczema Management in Children

The approach to managing eczema in children involves a combination of treatments, including:

• Topical corticosteroids, which are an essential part of the treatment regimen for children with atopic eczema 3
• Emollients, which constitute the preventive background therapy in all stages of eczema 4
• Infectious exacerbation may require the use of a short course of topical or systemic antimicrobials 4
• UV phototherapy, which can be considered as an adjunctive treatment to assist topical corticosteroids after an acute exacerbation of the disease 4
• Cyclosporine, which can be used in the treatment of childhood eczema in severe cases 4

Treatment Strategies

Different treatment strategies have been compared in clinical trials, including:

• Stronger-potency versus weaker-potency topical corticosteroids: moderate-potency topical corticosteroids probably result in more participants achieving treatment success than mild-potency topical corticosteroids 5
• Twice daily or more versus once daily application: applying potent topical corticosteroids only once a day probably does not decrease the number achieving treatment success compared to twice daily application 5
• Twice weekly application (weekend, or 'proactive therapy') to prevent relapse (flare-ups) versus no topical corticosteroids/reactive application: weekend (proactive) therapy probably results in a large decrease in likelihood of a relapse 5

Non-Medicated Topicals

Non-medicated topicals, such as emollients, can relieve childhood eczema symptoms and reduce the need to use steroids in children 6

• Tar preparations, gamma-linoleic acid preparations, borage oil, and evening primrose oil may also be effective 6
• MAS063DP cream (Atopiclair) has been shown to be effective in relieving eczema symptoms 6

Short Bursts of Potent Topical Corticosteroids

Short bursts of potent topical corticosteroids may be as effective as prolonged use of a mild preparation for controlling mild or moderate atopic eczema in children 7

• A three-day burst of a potent corticosteroid was found to be equivalent to a mild preparation used for seven days in terms of reducing disease severity and improving quality of life 7