From the Guidelines
Managing eczema in children requires a multi-faceted approach focusing on skin hydration, inflammation control, and trigger avoidance, as recommended by the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1. The approach should include daily bathing with lukewarm water for 5-10 minutes followed by immediate application of thick moisturizers like petroleum jelly or ceramide-containing creams. For mild flares, use low-potency topical corticosteroids such as hydrocortisone 1% twice daily for 7-14 days, as outlined in the stepwise treatment algorithm for pediatric atopic dermatitis 1. Moderate to severe cases may require medium-potency steroids like triamcinolone 0.1% for the body or desonide 0.05% for face/skin folds. Topical calcineurin inhibitors (tacrolimus 0.03% or pimecrolimus 1%) are effective for sensitive areas and maintenance therapy. Some key points to consider in the management of eczema in children include:
- Identifying and eliminating triggers, including harsh soaps, fragrances, certain fabrics, dust mites, and food allergens
- Considering systemic therapy with dupilumab (weight-based dosing) under specialist care for severe cases unresponsive to topicals 1
- Using antihistamines like hydroxyzine (0.5-1mg/kg/dose) to help with sleep disturbance from itching
- Implementing wet wrap therapy for severe flares, which involves applying medication, covering with damp gauze, and then dry clothing for 2-8 hours The decision to initiate systemic therapy should be based on the severity of the disease and the patient's response to topical therapy, as recommended by the international eczema council 1. It is essential to note that the management of eczema in children should be individualized, and the treatment approach may vary depending on the child's specific needs and circumstances. Overall, the goal of managing eczema in children is to restore skin barrier function, reduce inflammation, and minimize immune system overreaction, while also improving the child's quality of life.
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. ELIDEL Cream is used on the skin for short periods, and if needed, treatment may be repeated with breaks in between. Use ELIDEL Cream exactly as prescribed. 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 for children aged 2 years and older
- Applying a thin layer of ELIDEL Cream only to the affected skin areas, twice a day
- Using the smallest amount of ELIDEL Cream needed to control the signs and symptoms of eczema
- Stopping ELIDEL Cream when the signs and symptoms of eczema go away, or as directed by the doctor
- Repeating treatment with breaks in between if needed 2 2
From the Research
Approach to Managing Eczema in Children
The approach to managing eczema in children involves a multifaceted strategy that includes topical treatments, lifestyle modifications, and education on trigger avoidance.
- Topical corticosteroids (TCS) are considered a cornerstone treatment for atopic eczema in children, as they are effective in managing inflammation with minimal adverse effects when used appropriately 3.
- Alternative treatments, such as topical tacrolimus, have been found to be effective in treating moderate to severe atopic dermatitis without causing atrophy, and can be used in children and adults alike 4.
- Exclusive breastfeeding for at least six months and prebiotics may reduce eczema incidence in high-risk participants, although more research is needed to confirm these findings 5.
- Management of eczema in school-aged children should focus on identifying and managing triggers, as well as educating the child and their family on how to manage the condition from a general practice perspective, with referral to specialist services when necessary 6.
- A treatment update for managing eczema in children should include evidence-based reviews and easy-to-use treatment formulas to answer questions about the best way to manage pediatric atopic dermatitis, including the effectiveness of alternative remedies 7.
Treatment Options
Treatment options for eczema in children include:
- Topical corticosteroids (TCS) for managing inflammation
- Topical tacrolimus for moderate to severe atopic dermatitis
- Exclusive breastfeeding for at least six months to reduce eczema incidence in high-risk participants
- Prebiotics to reduce eczema incidence in high-risk participants
- Lifestyle modifications, such as avoiding triggers and using emollients to moisturize the skin
Education and Support
Education and support are crucial in managing eczema in children, including: