From the Guidelines
Treatment for papular eczema in children should involve a combination of moisturizing, topical medications, and trigger avoidance, prioritizing gentle, fragrance-free moisturizers and low-potency topical corticosteroids as first-line treatments. When considering treatment options, it's essential to weigh the benefits and risks of each approach, focusing on reducing inflammation, restoring the skin barrier, and preventing the itch-scratch cycle that worsens the condition 1.
Key Treatment Strategies
- Start with gentle, fragrance-free moisturizers like CeraVe, Eucerin, or Vanicream applied at least twice daily, especially after bathing while the skin is still damp.
- For mild to moderate flares, use low-potency topical corticosteroids such as hydrocortisone 1% cream twice daily for 7-10 days.
- For more severe cases, medium-potency options like triamcinolone 0.1% may be needed, but use these for no more than 2 weeks on the body and avoid the face.
- Non-steroidal alternatives include tacrolimus ointment (0.03%) or pimecrolimus cream for sensitive areas like the face, as supported by the conclusions of the Topical Calcineurin Inhibitor Task Force 1.
Additional Considerations
- Keep baths lukewarm and short (5-10 minutes), using mild, fragrance-free cleansers.
- Identify and avoid triggers such as harsh soaps, certain fabrics, dust mites, pet dander, and food allergens.
- Dress children in loose-fitting, cotton clothing and keep fingernails short to minimize damage from scratching.
- If symptoms don't improve within two weeks or if there are signs of infection (increased redness, warmth, pus, or fever), consult a healthcare provider promptly, considering the need for off-label therapy in children less than 2 years of age with poorly controlled persistent atopic dermatitis 1.
From the FDA Drug Label
CLINICAL STUDIES Three randomized, double-blind, vehicle-controlled, multi-center, Phase 3 studies were conducted in 589 pediatric patients ages 3 months-17 years old to evaluate ELIDEL ® (pimecrolimus) Cream 1% for the treatment of mild to moderate atopic dermatitis Two of the three trials support the use of ELIDEL Cream in patients 2 years and older with mild to moderate atopic dermatitis
The treatment options for papular eczema (atopic dermatitis) in pediatric patients include:
- Topical pimecrolimus (ELIDEL) Cream 1% for patients 2 years and older with mild to moderate atopic dermatitis 2
- Medium potency topical corticosteroid (optional sequential use) in pediatric patients 2
From the Research
Treatment Options for Papular Eczema (Atopic Dermatitis) in Pediatric Patients
- Topical calcineurin inhibitors, such as pimecrolimus cream 1% (Elidel) and tacrolimus ointment, have been shown to be effective in treating mild to moderate atopic eczema in pediatric patients 3, 4, 5
- Pimecrolimus cream 1% has been found to be well tolerated and effective in reducing pruritus and erythema, with a significant reduction in the incidence of flares and the amount of topical corticosteroid used 3
- Tacrolimus ointment has been shown to be effective in treating moderate to severe atopic dermatitis, with a significant improvement in disease severity and a reduction in the risk of flares 4, 5
- Topical corticosteroids (TCS) are also commonly used to treat atopic eczema, but their long-term use can be associated with significant adverse effects 5, 6
- Emollients are an essential part of the treatment regimen for atopic eczema, and can be applied in any order with topical corticosteroids without affecting the severity of the disease 6
- Systemic medical therapies, such as traditional immunosuppressants, biologics, and small molecule inhibitors, may be necessary for severe cases of atopic dermatitis that do not respond to topical treatments 7
- Phototherapy may also be considered as a treatment option for severe atopic dermatitis in pediatric patients 7
- Nonpharmacologic interventions, such as avoiding triggers and maintaining good skin care, are also important in managing atopic eczema in pediatric patients 7