From the Guidelines
For eczema on the face of an 11-year-old child, the best first-line medication is a low-potency topical corticosteroid such as hydrocortisone 1% cream or ointment. This recommendation is based on the principle of using the least potent preparation required to keep the eczema under control, as emphasized in the study by the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London 1.
When using topical corticosteroids, it is essential to explain the benefits and risks to the patient or their parents, as lack of adherence to treatment may often be traced back to fears of steroids 1. The treatment should be applied as a thin layer to affected areas twice daily for 7-10 days.
Key considerations for managing facial eczema include:
- Using low-potency steroids to minimize side effects like skin thinning
- Transitioning to daily moisturizing with a fragrance-free, hypoallergenic moisturizer after the acute flare resolves
- Avoiding triggers such as harsh soaps, fragrances, and extreme temperatures
- Consulting a healthcare provider if the eczema doesn't improve within a week or worsens
Additional measures to manage symptoms include bathing in lukewarm (not hot) water followed by immediate moisturizing. It is crucial to prioritize the patient's quality of life and minimize potential morbidity associated with untreated or poorly managed eczema.
From the Research
Treatment Options for Atopic Dermatitis
- Topical corticosteroids are a common first-line treatment for atopic dermatitis in children, including those with facial involvement 2, 3, 4
- The potency of the topical corticosteroid may vary depending on the severity of the eczema, with moderate-potency topical corticosteroids probably being more effective than mild-potency ones 4
- Pimecrolimus cream 1% (Elidel) is a topical calcineurin inhibitor that has been shown to be effective and well-tolerated in pediatric patients with mild to moderate atopic eczema, particularly on the face and neck 5
Considerations for Pediatric Patients
- Atopic dermatitis is a common condition in children, and its management is critical to reduce inflammation, alleviate pruritus and sleep disturbance, and improve quality of life 6
- The treatment approach may involve a combination of topical medications, phototherapy, and systemic medical therapies, depending on the severity of the condition 6
- Nonpharmacologic interventions, such as moisturizing and avoiding triggers, are also important in the management of atopic dermatitis in pediatric patients 6
Specific Considerations for Facial Involvement
- Pimecrolimus cream 1% (Elidel) may be a suitable option for treating atopic dermatitis on the face, as it has been shown to be effective and well-tolerated in this area 5
- Topical corticosteroids can also be used on the face, but careful consideration should be given to the potency and potential side effects, such as skin thinning 4