Can ammonium lactate be used to treat eczema in children?

Can Ammonium Lactate Be Used for Eczema in Children?

Ammonium lactate can be used as an emollient for dry, scaly skin in children with eczema, but it is not a first-line treatment and should not replace topical corticosteroids for active disease. 1

Role in Eczema Management

Ammonium lactate is FDA-approved for treating dry, scaly skin (xerosis) and ichthyosis vulgaris, and for temporary relief of itching associated with these conditions 1. While eczema commonly presents with dry skin, the primary treatment algorithm differs:

First-Line Treatment Hierarchy

• Topical corticosteroids remain the mainstay of treatment for active eczema in children, with mild to moderate potency preparations (such as 1% hydrocortisone) recommended as first-line therapy 2
• Emollients are essential as foundational therapy and should be applied liberally and regularly to maintain skin hydration, especially after bathing when skin is still damp 3, 2
• Standard emollients (not specifically ammonium lactate) are emphasized in guidelines as the core preventive background therapy in all stages of eczema 3

When Ammonium Lactate May Be Considered

Ammonium lactate functions as a moisturizing agent that can improve stratum corneum hydration and barrier function 4. It may have a role as:

• An adjunctive emollient option for the xerotic (dry skin) component of eczema, particularly in older children
• A potential protective agent when used alongside topical corticosteroids, as research suggests 12% ammonium lactate may help mitigate corticosteroid-induced skin atrophy 5

Critical Safety Considerations in Children

Age-Specific Precautions

• Safety and effectiveness have been demonstrated in infants and children according to FDA labeling, with no unusual toxic effects reported 1
• However, the product is for external use only and requires careful application 1

Application Warnings

• Stinging or burning commonly occurs when applied to skin with fissures, erosions, or abraded areas (such as after scratching), which is particularly relevant in eczema where skin barrier is compromised 1
• Caution is advised when used on the face due to potential for irritation 1
• Avoid contact with eyes, lips, or mucous membranes 1
• Minimize sun exposure on treated areas, as ammonium lactate formulations enhanced ultraviolet light-induced skin tumor formation in animal photocarcinogenicity studies 1

Comparative Tolerability

• Lactic acid preparations with strontium cause significantly less burning/stinging than ammonium lactate 12% (P<0.0001), which may be relevant when selecting emollients for children with sensitive, inflamed eczematous skin 6

Practical Algorithm for Use

If considering ammonium lactate in a child with eczema:

1. First ensure adequate topical corticosteroid therapy is in place for active inflammation 2
2. Use it as a supplementary emollient, not as primary eczema treatment 1
3. Start with test application to assess for stinging/burning, particularly if skin has active fissures or erosions 1
4. Avoid facial application in young children due to irritation risk 1
5. Protect treated areas from sun exposure with clothing 1
6. Discontinue if skin condition worsens with treatment 1

Common Pitfalls to Avoid

• Do not substitute ammonium lactate for topical corticosteroids in active eczema—this would constitute undertreatment of inflammatory disease 2
• Do not apply to actively inflamed, weeping, or infected eczema where stinging will be pronounced and tolerability poor 1
• Do not use as monotherapy expecting disease control—emollients alone, while essential, are insufficient for managing active atopic eczema 3, 2