The goals of eczema treatment include improvement in your child’s rash so that you or your child can participate fully in social and school activities, experience minimal or no side effects from medicines and sleep without waking up from itching. Management should be approached in a step-wise fashion depending on the severity of dermatitis.
The following steps are one potential approach that can be taken:
Mild Atopic Dermatitis
- Bathe or shower once each day using warm, but not hot, water for about 10 minutes.
- A mild soap should be used as needed.
- Gently pat away water and immediately apply a moisturizer or skin medication such as a topical steroid, to the skin rash while the skin is still damp.
- Low-potency topical corticosteroids (such as hydrocortisone ointment/cream, Aclovate ointment/cream, Desonide ointment/cream) or a topical calcineurin inhibitor (e.g. pimecrolimus 1 percent cream or tacrolimus 0.03 percent or 0.01 percent ointment) can be used to areas of mild eczema twice daily.
- Bland moisturizers should be applied generously to clear areas immediately after the bath or shower. Moisturizers may be applied on top of topical steroids or calcineurin inhibitors, but not until these have absorbed into the skin (at least 30 minutes or longer).
Moderate or Severe Atopic Dermatitis
- Bathe once or twice daily for about 10 minutes each in warm water, morning and evening.
- Gently pat away water and immediately apply a skin medication to the skin rash while the skin is still damp.
- Calcineurin inhibitors (e.g. pimecrolimus 1 percent cream or tacrolimus 0.03 percent or 0.01 percent ointment) can be applied on any affected part of the body two times a day, including the face, groin and underarms.
- Alternatively, a medium strength topical corticosteroid (e.g. triamcinolone ointment, fluticasone propionate ointment/cream, mometasone ointment/cream) can be applied to affected areas on the body and hands, and low-potency corticosteroids applied to the face, groin and underarms, twice a day. Topical steroids should generally be limited to three to four weeks of continuous usage.
- A moisturizer should be applied to the unaffected areas of the skin within minutes after bathing. Moisturizers may be applied on top of topical steroids or calcineurin inhibitors but not until these have absorbed into the skin (at least 30 minutes).
- Use Cetirizine (e.g. Zyrtec) 10 mg or another non-sedating antihistamine each morning for nasal allergies which can aggravate facial eczema due to scratching of the nose.
- Use a sedating antihistamine like diphenhydramine (e.g. Benadryl) or Hydroxyzine (e.g. Atarax) at night if you need help with sleep and control of itching.
- After resolution of acute inflammation, apply maintenance calcineurin inhibitors (e.g. pimecrolimus 1 percent cream or tacrolimus 0.03 percent or 0.01 percent ointment) twice a day for at least another week then at the first signs of itching or topical corticosteroids (e.g. fluticasone propionate or mometasone) two times a week to areas of skin that frequently flare.
Severe Atopic Dermatitis/Acute flares
- Bathing can be increased up to three times daily for 10-20 minutes each in warm water, occurring morning, mid-day (optional) and at bedtime.
- Apply a high-potency topical corticosteroid (e.g. fluocinonide ointment/cream, betamethasone dipropionate ointment/cream, clobetasol propionate ointment/cream) to areas of the body, arms and legs with eczema involvement after the morning and bedtime bath. BE AWARE that prolonged use of high potency topical corticosteroid can result in skin atrophy, skin stretch marks or other side effects. Therefore, this must be done under the supervision of your physician.
- Calcineurin inhibitors (pimecrolimus 1 percent cream or tacrolimus 0.03 percent or 0.01 percent ointment)can be applied on any affected part of the body two times a day, including the face, groin and underarms.
- Moisturizers should be applied to the unaffected areas after morning and bedtime bath and to the entire body after the mid-day bath.
- Use sedating antihistamines like diphenhydramine (e.g. Benadryl) or Hydroxyzine (e.g. Atarax) at bedtime for severe itching or sleep disturbance. If these don’t work, speak to your doctor about a stronger sleep medication.Use cetirizine (e.g. Zyrtec) 10 mg or another non-sedating antihistamine each morning for nasal allergies.
- Ask your physician about possible bacterial or viral skin infection. If present, use medication to eliminate the infection.
Assess whether allergens may be triggering your eczema.
- After resolution of acute inflammation, apply maintenance topical corticosteroids (as prescribed by your physician) two to three times a week to areas of skin that frequently flare. Alternatively, your physician may prescribe calcineurin inhibitors (pimecrolimus 1 percent cream or tacrolimus 0.03 percent or 0.01 percent ointment to be applied topically (usually twice a day for at least another week then at the first signs of itching).
- Control of severe atopic dermatitis may require phototherapy or systemic anti-inflammatory drugs such as prednisone, cyclosporine, etc. These should be done under the supervision of an atopic dermatitis specialist.
Other Treatments
- Wet wraps, under a doctor’s supervision, may be used as an intensive treatment for severe flares. Learn more.
- Bleach baths can help reduce the number of infections and possibly reduce the need for antibiotics. Learn more. Alternative treatments may include certain types of body washes that are better-suited for adolescents.