Moderate-to-Severe Eczema: A Pediatrician’s Treatment Guide

*This post is sponsored, but this journey and all opinions are 100% my own.*

As a parent, there is nothing more heartbreaking than being unable to make our child feel better. Many times, for children suffering from moderate to severe eczema, the emotional stress is just as painful as the physical symptoms. Missed schools days, frequent trips to doctors, and teasing can affect a child’s confidence and emotional well being. Finding an eczema treatment for kids that actually works for your child is sometimes tricky but so important on many different levels.

So today, we want to discuss the importance of finding that just right eczema treatment plan for kids (and adults alike).

Eczema Treatment for Kids

There is never a one-size-fits-all remedy in medicine. Every person has a unique journey that requires different treatment plans with varying results. What might work miracles for one patient might not work at all for another.

For many, the journey to a successful treatment plan involves a lot of frustration and stress. Many people eventually turn to several doctors and try many different medications before finding an equation that works.

As a pediatrician, I find that eczema often provides the most stress and uncertainty for parents. Many parents feel lost when it comes to successful treatments. I often hear from my parents, “I tried this cream. It worked for a little bit, but now it is worse than ever.” Or they say, “Every doctor keeps prescribing me the same cream that doesn’t work.”

Only about one-half of parents of children with atopic dermatitis or adults with atopic dermatitis have received a written eczema care plan from their healthcare provider.

Winter Skin Problems

We have a tough season ahead of us! In the colder months, winter skin problems often become more apparent. And as we are entering the coldest months of the year in many parts of the country, eczema can become a more severe issue.

In addition to the cooler, dryer air, a lack of vitamin D from the sun in the winter months can play a role in exacerbating eczema symptoms in some patients. It is so important to have the tools we need to help our children.

Eczema and Treatment Plans for Kids

Eczema is the general name for a group of dermatologic conditions, including contact dermatitis, atopic dermatitis, and others.

Atopic dermatitis is one of several eczema conditions. It is a chronic condition and therefore more challenging to manage. Atopic dermatitis (also known as atopic eczema) can require long-term treatment.

But today, I want to break down a treatment plan that can work in many cases! I’ll provide an excellent resource for parents to educate themselves on different treatments options. I also have a way to open up the conversation with healthcare providers about different options for healing.

So let’s start!

Climbing the Eczema Ladder

Atopic eczema often occurs with other allergic/atopic conditions, such as allergy, asthma, hay fever, and food allergies.

• 10% to 25% of children have atopic dermatitis; of which, approximately one-third have moderate-to-severe disease
• 5% to 10% of adults have atopic dermatitis (3% of elderly); of which, approximately one-third have moderate-to-severe disease

So where do you start with eczema treatment for kids?

If you or a loved one has eczema, it’s helpful to think of the treatment journey as a therapeutic ladder based on the severity of your atopic dermatitis. Simply start on the lowest levels and work your way up, as needed.

Step 1: Basic Skincare

The first step on the ladder is gentle skincare treatments. Use oil-based soaps and cleansers without preservatives. Don’t forget to moisturize the skin. In fact, for many people, moisturizing the skin can be enough, although these products can sometimes be expensive.

Identifying and avoiding possible irritants and allergens is important. It can be challenging to avoid triggers that cause or aggravate a flare up.

Common triggers include fragrances, wool or other coarse fabrics, certain foods, or transitions or extremes in humidity and/or temperature. Identifying triggers can be difficult, so it is important to speak with your healthcare provider, as allergy testing may help identify specific triggers.

Step 2: Topical Therapies

The second step on the ladder is often topical ointments and creams. Providers often prescribe corticosteroids, although the long-term use of topical steroids is not recommended. Reduced steroid options are also available if basic skincare does not provide relief. Your pediatrician may also recommend steroid-free options for sensitive body parts, such as the face or diaper area.

These options are best for mild or moderate atopic dermatitis or in combination with systemic therapies for more severe disease.

Moving up to the next level on the ladder is often necessary for moderate-to-severe atopic dermatitis patients.

Phototherapy is another option if topical options don’t appear to be working. However, this treatment can be time consuming and expensive.

Step 3: Systemic Therapies

Systemic therapies are best for moderate-to-severe cases of atopic eczema.

One treatment option for patients with severe cases of atopic eczema is nonspecific immunosuppressants, such as systemic corticosteroids. However, these treatments can sometimes cause rebound flare ups and multiple adverse effects with long-term use.

Your child’s pediatrician may prescribe other immunosuppressant therapies. However, these treatments are not always FDA-approved and may require laboratory work.

However, newer systemic agents are now available and FDA-approved. These treatments target the underlying causes of atopic dermatitis, including the factors that cause itch and inflammation.

Additionally, patients 6 years of age and older with moderate-to-severe atopic dermatitis can use dupilumab if they cannot control their eczema with topical therapies.

Even with these advanced treatments, topical medications may also come in handy.

Final Thoughts on Eczema Treatment Plans for Kids

Because atopic dermatitis is a chronic condition, a formal plan or “Eczema Action Plan” can help you stay on track. Work closely with your child’s pediatrician to develop an eczema treatment for kids that works for your family.

Speaking of your pediatrician, many parents wonder whether they should see their child’s pediatrician or a dermatologist if their child is experiencing eczema. This decision depends on your child’s treatment results. Some pediatricians are comfortable treating up the ladder, but others are not. Therefore, you may need help from a dermatologist or pediatric dermatologist at some point in your eczema journey.

It is also important to seek additional care if treatments are not working despite following a treatment plan. Do not settle for poor results or eczema that does not resolve. A treatment change may be in order.

Follow your treatment instructions carefully. If your symptoms don’t improve or you experience any side effects, your doctor can determine whether another treatment is right for you.

~Dr. Katie

 

 

I was compensated by Med-IQ through an educational grant from Sanofi Genzyme and Regeneron Pharmaceuticals to write about the signs, symptoms, and treatments available for atopic dermatitis or eczema. All opinions are my own.

Med-IQ is an accredited medical education company that provides an exceptional educational experience for physicians, nurses, pharmacists, and other healthcare professionals.

As a pediatrician, I chose to partner with Med-IQ to help generate awareness around the signs, symptoms, and treatments for eczema and atopic dermatitis.

*Links to external sites are provided as a convenience and for informational purposes only. They are not intended and should not be construed as legal or medical advice, nor are they endorsements of any organization. Med-IQ bears no responsibility for the accuracy, legality, or content of any external site. Contact the external site for answers to questions regarding its content.

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