Treatment of Eczema in Children

First-Line Treatment

The American Academy of Pediatrics recommends mild to moderate potency topical corticosteroids as first-line therapy for infantile and childhood eczema, with careful consideration of potency based on severity and affected body areas 2
The British Medical Journal suggests using the least potent preparation required to keep the eczema under control, and when possible the corticosteroids should be stopped for short periods 1
Emollients are essential for maintaining skin hydration and should be applied regularly, especially after bathing when the skin is still damp 2
Avoid irritants such as soaps, detergents, and wool clothing that can exacerbate eczema; cotton clothing is more comfortable and recommended 3
Keep nails short to minimize damage from scratching 3

For mild eczema, low-potency corticosteroids (hydrocortisone 1%) are recommended 4
For moderate eczema, low to medium potency corticosteroids are suggested 4
For severe eczema, medium to high potency corticosteroids for short periods (3-7 days) may be used 4
For sensitive areas such as face, neck, and skin folds, use only low-potency corticosteroids to avoid skin atrophy 4

Tacrolimus 0.03% ointment and pimecrolimus 1% cream are effective alternatives for sensitive areas such as the face and genital regions 2, 4
Ichthammol (1% in zinc ointment) is less irritant than coal tars and can be applied as an ointment or in paste bandages, particularly useful for lichenified areas 1
Coal tar solution (1% in hydrocortisone ointment) can be effective and does not cause systemic side effects unless used excessively 1

Secondary bacterial infection (usually Staphylococcus aureus) requires antibiotic treatment, with flucloxacillin as the first choice for S. aureus infections; erythromycin may be used for penicillin-allergic patients 1, 2
Eczema herpeticum (herpes simplex infection) requires prompt treatment with oral acyclovir; use intravenous acyclovir for ill, febrile patients 1

Sedating antihistamines may be useful as short-term adjuncts during severe itching episodes, particularly at night 1, 2
Non-sedating antihistamines have little value in atopic eczema 1

Regular use of emollients has a short and long-term steroid-sparing effect 4
For moderate to severe eczema, proactive therapy with twice-weekly application of topical corticosteroids to previously affected areas may prevent relapses 4

Avoid high-potency or ultra-high-potency topical corticosteroids in infants and young children due to increased risk of hypothalamic-pituitary-adrenal (HPA) axis suppression 2, 4
The risk of adverse effects increases with higher potency, occlusion, and prolonged use of topical corticosteroids 2, 4
Monitor for signs of skin atrophy, striae, or systemic absorption 4