What is the treatment for atopic dermatitis (eczema) in a 6-year-old child?

From the Guidelines

For treating eczema in a 6-year-old child, the most effective approach is to focus on gentle skin care and appropriate medications, as outlined in the most recent guidelines from 2022 1.

Key Recommendations

• Start with daily lukewarm baths (5-10 minutes) using mild, fragrance-free soap, followed by patting the skin dry and applying a thick moisturizer like petroleum jelly, Cerave, or Eucerin within 3 minutes to lock in moisture.
• For mild flares, use over-the-counter 1% hydrocortisone cream twice daily for up to 7 days on affected areas.
• For moderate to severe eczema, a pediatrician may prescribe stronger topical steroids like triamcinolone 0.1% or fluticasone 0.05% for short-term use, or non-steroidal options like tacrolimus (Protopic) or pimecrolimus (Elidel), as supported by studies such as 2.

Additional Considerations

• Avoid known triggers such as harsh soaps, fragrances, certain fabrics, dust mites, and stress.
• Dress the child in soft cotton clothing, keep fingernails short to minimize damage from scratching, and use wet wrap therapy for severe flares (applying medication, moisturizer, then damp bandages covered by dry ones).
• An oral antihistamine like cetirizine (5mg daily) or diphenhydramine (12.5mg) at bedtime can help with itching, as suggested by general principles of managing atopic dermatitis 3.
• If signs of skin infection appear (increased redness, warmth, yellow crusting), consult a doctor promptly as antibiotics may be needed, highlighting the importance of monitoring for complications 4.

From the FDA Drug Label

ELIDEL ® (pimecrolimus) Cream 1% is indicated as second-line therapy for the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children 2 years of age and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable. Two of the three trials support the use of ELIDEL Cream in patients 2 years and older with mild to moderate atopic dermatitis

For a 6-year-old child with eczema, pimecrolimus (TOP) cream can be used as a second-line therapy for the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis, if the child has failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable 5.

• Key considerations:
  • The child is non-immunocompromised
  • The child is 2 years of age or older
  • The treatment is not continuous, but rather short-term 6

From the Research

Eczema Treatment in 6-Year-Old

• Eczema, also known as atopic dermatitis, is a chronic relapsing and remitting inflammatory skin disease that affects one in 10 people in their lifetime 7.
• The American Academy of Dermatology has created simple diagnostic criteria based on symptoms and physical examination findings, and maintenance therapy consists of liberal use of emollients and daily bathing with soap-free cleansers 7.
• Topical corticosteroids are the first-line treatment for atopic dermatitis flare-ups, and pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment 7.

Topical Corticosteroids

• Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema 8.
• Effectiveness is similar between once daily and twice daily (or more) frequent use of potent topical corticosteroids to treat eczema flare-ups 8.
• Topical corticosteroids weekend (proactive) therapy is probably better than no topical corticosteroids/reactive use to prevent eczema relapse (flare-ups) 8.

Application of Emollient and Topical Corticosteroids

• The order of application of emollient and topical corticosteroids does not matter in the treatment of atopic eczema in children, and parents can apply topical medications in whichever order they prefer 9.
• Therapeutic efficacy of topical corticosteroids depends upon selecting the appropriate vehicle and potency, and the frequency of application, also taking into account the duration of treatment and patient preferences 10.

Systemic Corticosteroids

• Guidelines discourage the use of systemic corticosteroids for atopic dermatitis, but their use remains widespread 11.
• Systemic corticosteroids should generally be avoided but can be used rarely for severe atopic dermatitis under certain circumstances, including a lack of other treatment options, as a bridge to other systemic therapies or phototherapy, during acute flares in need of immediate relief, in anticipation of a major life event or in the most severe cases 11.