How to Treat Eczema in Children

The best treatments for eczema are moisturizing and removing the irritant.

Some cases of eczema may be treated with a steroid cream or a nonsteroidal anti-inflammatory cream. These are used in addition to moisturizers. Steroid creams come in a range of strengths. Over-the-counter creams contain either 0.5 percent or 1 percent steroid. Prescription creams can contain 2.5 percent steroid or more. These creams have some side effects if they are used too often or over too big an area, because the body absorbs the steroid. When too much is absorbed, side effects such as mood or appetite changes can result. However, it is important to empha­size that this is extremely rare. More commonly, steroid creams used in the same area over time can cause the skin to thin, chang­ing the pigmentation. Among the steroid creams are the mild steroid hydrocortisone 1 percent (sold under a number of brand names, including Cortaid), the moderate steroid triamcinolone acetonide (Aristocort), and the strong steroids fluticasone propi­onate (Cutivate) and mometasone furoate (Elocon).

Nonsteroidal anti-inflammatory creams are an alternative to steroid creams. The two used with children are tacrolimus (Pro-topic) and pimecrolimus (Elidel). Both of these work well to calm inflamed skin. Initially, they were thought to have fewer side effects than steroids. However, in 2005 a warning was added to the label identifying a potential increased risk of cancer with use of these nonsteroidal creams. This issue is being studied, and the current recommendation is to avoid using these creams in young children, especially those under two years.

What are the possible complications?

When the skin becomes so dry that it cracks, it can easily become infected. Likewise, when a child scratches an irritated area, the skin can break, and a secondary infection may result. Skin infec­tions may require antibiotic treatment.

Many other conditions are associated with eczema. These include asthma, rashes other than eczema (such as hives), ear infections, and sinus infections. Like eczema, these conditions occur because of inflammation somewhere in the body — lungs, skin, sinuses, and so on — making it difficult for that part of the body to work effectively. In the lungs, inflammation makes breath­ing difficult because it clogs the airways. In the skin, inflamma­tion causes swelling, irritation, and itchiness. In the sinuses, inflammation causes congestion, creating an environment ripe for bacterial infections. Because inflammation lies at the core of all these problems, it is not uncommon to discover that a child with eczema also has other skin sensitivities, allergies, sinus problems, or asthma. In fact, one triad is so common — eczema, asthma, and allergy — that it has a name: atopy.

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