From the Guidelines
Management of severe chronic eczema in an 8-month-old child requires a comprehensive approach focusing on skin hydration, inflammation control, and trigger avoidance, with the cornerstone of treatment being regular application of emollients and use of low-potency topical corticosteroids. The most recent and highest quality study, 1, recommends oral antihistamines as adjuvant therapy for reducing pruritus in atopic dermatitis, and dupilumab as a treatment for severe to very severe AD that is refractory to conventional topical treatment. However, for an 8-month-old child, the use of dupilumab may not be recommended due to limited data on its safety and efficacy in this age group.
Some key points to consider in the management of severe chronic eczema in an 8-month-old child include:
- Regular application of emollients like petroleum jelly, Eucerin, or Cetaphil at least 2-3 times daily, especially after bathing while the skin is still damp to lock in moisture.
- Use of low-potency topical corticosteroids such as hydrocortisone 1% or desonide 0.05% ointment on affected areas twice daily for 7-14 days during flares, then taper to intermittent use, as recommended by 1.
- Avoidance of medium or high-potency steroids in infants due to increased absorption risks.
- Bathing should be limited to 5-10 minutes in lukewarm water using mild, fragrance-free cleansers.
- Identification and elimination of triggers including harsh soaps, fragrances, certain fabrics (wool, polyester), dust mites, pet dander, and potentially allergenic foods.
- Dressing the child in loose-fitting cotton clothing and keeping fingernails short to minimize damage from scratching.
- Antihistamines like cetirizine (2.5mg daily) may help with sleep disruption from itching, as recommended by 1.
It is also important to note that, according to 1, if maternal allergen elimination is trialed to manage severe infantile eczema, it is imperative that a period of reintroduction is used to re-elicit symptoms and confirm the diagnosis before longer periods of dietary restriction. However, this approach should be taken with caution and under the guidance of a healthcare professional.
Overall, the management of severe chronic eczema in an 8-month-old child requires a multi-faceted approach that addresses both the skin barrier dysfunction and immune dysregulation that characterize atopic dermatitis, helping to break the itch-scratch cycle while promoting skin healing, as recommended by 1.
From the FDA Drug Label
Adults and children 2 years of age and older: apply to the affected area not more than 3 to 4 times daily. Children under 2 years of age: do not use, consult a doctor. Stop using this product and ask a doctor if conditions worsen symptoms persist for more than 7 days or clear up and occur again within a few days, discontinue use of this product and do not begin use of any other hydrocortisone product unless directed by a doctor.
The management of severe chronic eczema (atopic dermatitis) in an 8-month-old child is not directly stated in the provided drug labels. However, it is clear that hydrocortisone products should not be used in children under 2 years of age without consulting a doctor 2.
- For children under 2 years, the labels advise to consult a doctor.
- The labels do not provide information on the causes of severe chronic eczema in an 8-month-old child. Given the information provided, it is recommended to consult a doctor for the management of severe chronic eczema in an 8-month-old child 2, 2.
From the Research
Causes of Severe Chronic Eczema in Children
- Atopic dermatitis (AD), or eczema, is a chronic inflammatory skin condition characterized by relapsing pruritic, scaly, erythematous papules and plaques frequently associated with superinfection 3
- The exact cause of atopic dermatitis is unknown, but it is associated with a dramatic impact on quality of life for patients 4
- Environmental interventions and genetic factors may play a role in the development of atopic dermatitis 5
Management of Severe Chronic Eczema in Children
- Topical corticosteroids (TCS) are the cornerstone treatment of atopic eczema in children, and their use is very effective in treating active eczema with minimal adverse effects when used appropriately 6
- Basic therapy is focused on patient/family education, hydrating topical treatment, and avoidance of specific and non-specific provocative factors 5
- Anti-inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors is used for exacerbation management and more recently in selective cases for proactive therapy 5
- Systemic immunosuppressive treatment is an option for severe refractory cases, including cyclosporine, mycophenolate mofetil, methotrexate, and azathioprine 3
- Phototherapy represents a valid second-line intervention in those cases where non-pharmacological and topical measures have failed, with UVA1 and NB-UVB being the most commonly used forms 4
- Dietary recommendations should be specific and given only when food allergy is confirmed, and allergen-specific immunotherapy against aeroallergens may be useful in selected cases 5
Treatment Options for Severe Cases
- Systemic agents such as cyclosporine, mycophenolate mofetil, methotrexate, and azathioprine may be considered for severe cases of atopic dermatitis that do not respond to optimized topical therapy 3
- Phototherapy, including UVA1 and NB-UVB, may be used as a second-line treatment for severe cases of atopic dermatitis 4
- Ultraviolet (UV) irradiation, preferably with UVA1 or narrowband UVB, may be used as an adjuvant therapy for severe cases of atopic dermatitis 5