From the Guidelines
For mild to moderate eczema, proactive and reactive therapy with low to medium potency topical corticosteroids (TCSs) is recommended. According to the most recent guidelines, such as the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1, TCSs are the preferred option for managing eczema. Good options include hydrocortisone 1-2.5% for mild cases, particularly on sensitive areas like the face, and triamcinolone 0.025-0.1% or mometasone furoate 0.1% for moderate cases on the body.
Some key points to consider when using TCSs for eczema include:
- Apply a thin layer to affected areas once or twice daily for 1-2 weeks during flares, then taper to intermittent use as needed
- Use the medication after moisturizing for better absorption
- For maintenance, apply only 2-3 times weekly to prevent flares while minimizing side effects
- These medications work by reducing inflammation, itching, and redness by suppressing the immune response in the skin
- Side effects can include skin thinning, so avoid continuous use for extended periods, especially on the face and skin folds
It's also important to note that other options, such as topical PDE-4 inhibitors (crisaborole) or TCIs (pimecrolimus; tacrolimus), may be considered, but TCSs are generally the first line of treatment 1. If there's no improvement after two weeks of consistent use, or if the condition worsens, consult a healthcare provider for alternative treatments.
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 Two identical 6-week, randomized, vehicle-controlled, multi-center, Phase 3 trials were conducted to evaluate ELIDEL Cream for the treatment of mild to moderate atopic dermatitis.
The topical steroid to use for mild to moderate eczema is not explicitly mentioned in the provided text, however, it does mention the use of ELIDEL Cream (pimecrolimus) and a medium potency topical corticosteroid.
- Pimecrolimus is used for the treatment of mild to moderate atopic dermatitis.
- A medium potency topical corticosteroid can be used sequentially with ELIDEL Cream in pediatric patients. 2
From the Research
Topical Steroids for Mild to Moderate Eczema
- For mild to moderate eczema, moderate-potency topical corticosteroids are probably more effective than mild-potency topical corticosteroids, with an odds ratio (OR) of 2.07 (95% confidence interval (CI) 1.41 to 3.04) for treatment success, as defined by cleared or marked improvement on the Investigator Global Assessment (IGA) 3.
- Potent topical corticosteroids are also probably more effective than mild-potency topical corticosteroids, with an OR of 3.71 (95% CI 2.04 to 6.72) for treatment success 3.
- However, there is uncertain evidence to support any advantage of very potent over potent topical corticosteroids, with an OR of 0.53 (95% CI 0.13 to 2.09) for treatment success 3.
Comparison with Other Topical Treatments
- Topical pimecrolimus is less effective than moderate and potent corticosteroids and 0.1% tacrolimus for treating eczema 4.
- Tacrolimus is effective in treating atopic dermatitis, with over 90% improvement in disease severity in one third of patients with moderate to severe atopic dermatitis over a 12-week treatment period 5.
- A network meta-analysis found that potent topical corticosteroids, tacrolimus 0.1%, and ruxolitinib 1.5% were among the most effective treatments for improving patient-reported symptoms and clinician-reported signs of eczema 6, 7.
Application Frequency and Duration
- Applying potent topical corticosteroids once a day probably does not decrease the number of participants achieving treatment success compared to twice daily application, with an OR of 0.97 (95% CI 0.68 to 1.38) 3.
- There is a need for longer-term trials to determine the optimal duration of treatment for eczema flare-ups 3.
- Weekend (proactive) therapy with topical corticosteroids probably results in a large decrease in likelihood of a relapse, from 58% to 25% (risk ratio (RR) 0.43,95% CI 0.32 to 0.57) 3.