From the Guidelines
For mild facial eczema in a 1.5-year-old child, a low-potency topical corticosteroid such as hydrocortisone 1% cream is the recommended first-line treatment. According to the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis, topical corticosteroids (TCSs) are considered the first-line treatment for flare-ups and are effective in reducing the inflammatory immune response in atopic dermatitis (AD) 1. The guidelines also emphasize that children should be treated with less potent TCSs than those prescribed for adults, and the duration of exposure to potent TCSs in sensitive skin areas, such as the face, should be limited to avoid skin atrophy.
Some key points to consider when using topical corticosteroids for mild facial eczema in children include:
- Apply a thin layer to affected areas twice daily for 7-10 days
- Limit use on the face to short courses (typically no more than 2 weeks) to avoid side effects
- Maintain a good skincare routine with daily lukewarm baths followed by immediate application of a fragrance-free moisturizer to lock in moisture
- Avoid known triggers like harsh soaps, fragrances, and extreme temperatures
- Dress the child in soft, cotton clothing and keep fingernails short to minimize damage from scratching
It's also important to note that regular use of emollients has a short- and long-term steroid-sparing effect in mild to moderate AD, and certain moisturizers can improve skin barrier function 1. If symptoms don't improve within 7-10 days or worsen, consult your pediatrician as a different approach may be needed, such as considering non-steroidal alternatives like tacrolimus or pimecrolimus for facial eczema.
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. ELIDEL Cream is not indicated for use in children less than 2 years of age
The best first line medication for mild facial eczema in a 1.5 year old child is not pimecrolimus (TOP) as it is not indicated for use in children less than 2 years of age 2.
From the Research
Treatment Options for Mild Facial Eczema in Children
- Topical corticosteroids are a common treatment for eczema, including mild facial eczema in children 3, 4.
- The choice of topical corticosteroid potency and duration of use depends on the severity of the eczema and the patient's age and skin type 3.
- For children, lower potency topical corticosteroids and shorter durations of use are recommended to minimize the risk of adverse effects 3.
Comparison of Topical Corticosteroids and Other Treatments
- Topical pimecrolimus is an alternative to topical corticosteroids for treating eczema, but its efficacy and safety compared to existing treatments are unclear 5, 6.
- Pimecrolimus is less effective than moderate and potent corticosteroids and 0.1% tacrolimus for treating eczema 5.
- Topical corticosteroids are generally more effective than pimecrolimus for treating eczema, but may have a higher risk of adverse effects such as skin thinning 4, 7.
Safety of Topical Corticosteroids in Children
- The safety of topical corticosteroids in children with atopic eczema has been evaluated in several studies, with most finding no significant increased risk of adverse effects such as skin thinning or biochemical adrenal suppression 7.
- However, long-term safety data are limited, and more research is needed to fully understand the risks and benefits of topical corticosteroid use in children 7.