What is the recommended treatment for eczema in a 17-month-old child?

Treatment for Eczema in a 17-Month-Old Child

For a 17-month-old with eczema, the recommended treatment is a mild topical corticosteroid such as 1% hydrocortisone applied no more than 3-4 times daily, combined with liberal use of emollients. 1, 2

First-Line Treatment Approach

Emollients and Skin Care

• Use emollients liberally as the foundation of treatment
• Apply emollients after bathing when skin is still damp to lock in moisture
• Use emollients as soap substitutes (dispersible creams) instead of regular soaps/detergents
• Avoid irritants: wool clothing, extreme temperatures, and harsh soaps
• Dress child in cotton clothing

Topical Corticosteroids

• Use 1% hydrocortisone (mild potency) for children under 2 years 1
• Apply to affected areas no more than 3-4 times daily 1
• Use the minimum effective amount to control symptoms
• Treatment should not be applied more than twice daily in most cases 2

Managing Specific Issues

For Infection

If secondary bacterial infection is present (crusting, weeping):

• Flucloxacillin is usually the most appropriate antibiotic for Staphylococcus aureus 2
• Erythromycin may be used for penicillin-allergic patients 2

For Severe Itching

• Sedating antihistamines may be used short-term for severe pruritus, particularly at night 2
• Non-sedating antihistamines have little to no value in atopic eczema 2

Application Method

• The order of application between emollients and corticosteroids does not significantly affect treatment outcomes 3
• Allow 15 minutes between applications of different products
• Parents can apply in whichever order they prefer for better compliance 3

Treatment Duration

Research shows that short bursts of treatment can be effective. A study comparing short bursts of potent corticosteroids versus prolonged use of mild preparations found similar efficacy 4, but for children under 2 years, it's safest to stick with mild preparations like 1% hydrocortisone 2, 1.

Common Pitfalls to Avoid

1. Overuse of topical corticosteroids: Can lead to skin thinning and pituitary-adrenal axis suppression 2
2. Undertreatment due to steroid phobia: Explain to parents that appropriate use of mild steroids is safe 2
3. Neglecting emollients: These are the foundation of treatment and should be used liberally
4. Using non-sedating antihistamines: These have little value in treating eczema 2
5. Using potent corticosteroids in young children: Stick to mild preparations for this age group 2, 5

When to Refer to a Specialist

• If there's no response to first-line treatment
• If there's diagnostic doubt
• If there's severe or widespread eczema
• If there's recurrent infection

Remember that most children with eczema respond well to first-line management and don't require specialist referral 2.