Information for the public
Treating your child's atopic eczema
Treating your child's atopic eczema
Some treatments may not be suitable for your child, depending on the circumstances. If you have questions about the specific treatments and options covered in this information, please talk to a member of your child's healthcare team.
The NICE guideline says that treatment for your child's atopic eczema should be 'stepped up' or 'stepped down' depending on how severe the eczema is. For instance, if the eczema gets worse, your healthcare professional may advise using a different treatment. Different areas of skin may need to be treated differently if the eczema is more severe in some places than others.
Your healthcare professional should give you advice on recognising 'flares' of atopic eczema – this is when the skin becomes more dry, itchy, red or swollen. They should discuss this with you and make sure you have all the information and treatments you need to manage the atopic eczema when there is a flare. Flare treatment should be started as soon as symptoms appear, and carried on for at least 48 hours after the flare has stopped.
Your healthcare professional should take into account things like your child's normal bathing and skincare routines when deciding which treatments to offer. Your healthcare professional should spend time explaining to you and your child how to use all the treatments, as well as giving you and your child practical demonstrations and written information. The possible treatments are described in the following sections.
Emollients
Emollients are moisturisers and are an essential daily treatment for atopic eczema. They are not the same as cosmetic moisturisers. Emollients should be used as often and as generously as possible on all areas of skin, even when the atopic eczema has cleared. Emollients can be used on their own, or with other treatments, but should always be used more often and in larger amounts than other treatments. They can be used for moisturising, washing and bathing.
Your child should be prescribed leave-on emollients in large quantities (at least 250 g per week). Your healthcare professional should offer a choice of unperfumed emollients (this could be several emollients, or one for all purposes). If your child doesn't like a particular emollient or it irritates the skin, you should be offered a different one. Your healthcare professional should check at least once a year that the emollients your child is using are still suitable.
Your healthcare professional should show you and your child how to apply emollients, including how to smooth them on rather than rub them in. If any other treatment is being put on the skin at the same time of day, it doesn't matter which is applied first. You should leave at least a few minutes between applying each treatment.
Emollients should be used instead of soaps, bubble baths and shower gels, and instead of shampoo in children under 1 year old. If your child uses shampoo, it should be unperfumed, ideally labelled as being suitable for people with atopic eczema, and not used in the bath.
Topical corticosteroids
'Topical' means that something is applied to the skin. Topical corticosteroids are treatments that reduce inflammation, and are used to control flares of atopic eczema. They usually come as creams and ointments that are used once or twice a day. You should apply them to areas of eczema that are 'active' (that is, where the skin is itchy, dry, red or sore) or has been active in the last 48 hours, even if there are cracks, scratches or broken skin. Sometimes your healthcare professional may advise you to use a corticosteroid on areas of clear skin for 2 days a week to prevent flares where eczema keeps occurring.
Your healthcare professional should explain that the benefits of using topical corticosteroids outweigh the potential harms when they're used correctly. They should also talk to you about the different potencies and explain how they're used; the potency will depend on how severe the atopic eczema is and where it's located on your child's body. Use of potent topical corticosteroids in children under 12 months should be supervised by a specialist.
The NICE guideline has incorporated recommendations from NICE's technology appraisal guidance on frequency of application of topical corticosteroids for atopic eczema, which looked at how often topical corticosteroids should be applied for the treatment of atopic eczema.
Topical calcineurin inhibitors
Topical calcineurin inhibitors are treatments that help to reduce inflammation. They're usually used when atopic eczema is severe or lasts a long time, or when other treatments aren't working.
Calcineurin inhibitors should only be applied to areas of active atopic eczema, including if the skin is broken. They should not be used to treat mild atopic eczema or for children under 2 years. A healthcare professional who specialises in skin problems should supervise treatment with calcineurin inhibitors.
The NICE guideline has incorporated recommendations from NICE's technology appraisal guidance on tacrolimus and pimecrolimus for atopic eczema, which looked at how to use topical calcineurin inhibitors for the treatment of atopic eczema.
Dressings
Various types of dressings or bandages (known as dry wraps, wet wraps and occlusive dressings) can be used to treat atopic eczema. They work by reducing itchiness, preventing scratching and helping to stop the skin from drying out. A healthcare professional trained in using dressings should supervise their use if dressings are used with other treatments. A healthcare professional with specialist knowledge should also supervise treatment with dressings that cover the whole body, and they should not be the first treatment tried for your child. The NICE guideline says that occlusive medicated dressings and dry bandages should not be used to treat atopic eczema that is infected.
Other treatments
The NICE guideline says that drugs called antihistamines are not normally recommended; however, in certain situations (for example, if you or your child's sleep is being disturbed), an antihistamine may be tried.
If your child's atopic eczema is severe and all the treatments mentioned so far have not helped, your healthcare professional may consider some other types of treatment known as phototherapy and systemic therapy. A specialist should supervise these treatments.
Your healthcare professional may offer a trial of formula free from cow's milk if your child is under 6 months and bottle-fed. This formula should not be based on soya protein or goat's or sheep's milk. If your child is over 6 months, your healthcare professional may offer a diet based on soya protein, after getting specialist dietary advice.