From Emollients to Biologics: A Look at Treatments for Chronic Eczema in Children

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition that affects approximately 20% of children in the UK. It often presents before the age of 5 and can cause symptoms such as dryness, itching, and redness of the skin. The management of eczema in children requires a comprehensive approach that includes skincare routines, lifestyle modifications, and prescription medications.

Skincare Routines

Regular bathing and moisturising are crucial to control eczema flares. The “Soak and Seal” method is recommended by many providers to help dry skin and reduce flares. This involves soaking the child in lukewarm water for five to ten minutes, avoiding scrubbing the affected skin, patting the skin lightly with a towel leaving it slightly damp, applying prescription topical medication to the affected areas of skin as directed, and liberally applying a moisturiser all over the child’s body within three minutes.

Topical Corticosteroids

Topical corticosteroids are the first-line treatment for flare-ups. They reduce inflammation and itching1. The potency of the corticosteroid is selected based on the severity of the eczema and the age of the child. For children > 12 months old, potent corticosteroids should be used on affected areas for as short a time as possible, and maximum 14 days. Moderate potency steroids can be used on vulnerable areas for max 7 to 14 days. For delicate areas of skin such as the face and flexures, use a moderate potency corticosteroid (such as betamethasone valerate 0.025% or clobetasone butyrate 0.05%) for a maximum of 5 days’ use.

Bleach Baths

Bleach baths can help reduce the number of bacteria or “germs” on the skin. This can help prevent eczema flares. Regular use also seems to improve eczema generally. To make a bleach bath at the correct concentration carers should do the following:

• Run the bath to the preferred temperature. Do not add bubble bath or soap, as these dry the skin.
• Add half a cup (150ml) of bleach to at least 10cm depth of water in an adult bathtub (for a baby tub use 2ml bleach for every 1 litre of water).
• Mix well.
• Soak for 10-15 minutes.
• Rinse with plain water, then gently pat dry and moisturise/ apply creams as usual.
• Repeat twice a week, to help prevent eczema flares.

Immunosuppressant Medications

Immunosuppressants are prescribed for moderate to severe atopic dermatitis (AD) in children and adults. They can be used to help stop the itch-scratch cycle of eczema, to allow the skin to heal and reduce the risk of skin infection. There are a number of immunosuppressants, both traditional systemic medications and steroids, used for treating eczema.

Among the most common traditional systemic medications used to treat eczema are:

• Azathioprine: An oral medication first used in transplant patients to prevent the body from rejecting a transplanted organ.
• Cyclosporine: An oral or injectable medication first used in transplant patients to prevent the body from rejecting a transplanted organ.
• Methotrexate: An oral or injectable medication used frequently in psoriasis and different types of arthritis. It is a chemotherapy agent first used on cancer patients.
• Mycophenolate mofetil: Used in transplant patients and for other diseases of the immune system.

Biologics

Biologics are a newer class of drugs that target specific parts of the immune system. They are used in severe cases or when other treatments have not worked. Currently, only one biologic, dupilumab (Dupixent), has been approved by the Medicines and Healthcare products Regulatory Agency (MHRA) for the treatment of atopic dermatitis in children aged 6 years and older in the UK.

For more detailed information on the application of emollients in paediatric eczema, I recommend visiting the Practitioner Development UK website. They have an excellent article titled “Understanding and Applying Emollients in Paediatric Eczema” that provides comprehensive insights into this topic. Please note that external resources should always be used in conjunction with advice from a healthcare professional. Carers should always consult with a healthcare provider to determine the most appropriate treatment for each individual child. Different treatments may work better for different children, and it may take time to find the most effective approach.

References:

1. National Eczema Association, 2021. Eczema in children. [online] Available at: https://nationaleczema.org/eczema-in-children/ [Accessed 12 October 2023].
2. Australasian College of Dermatologists, 2021. Eczema (atopic dermatitis). [online] Available at: https://www.dermcoll.edu.au/atoz/eczema-atopic-dermatitis/ [Accessed 12 October 2023].
3. British Association of Dermatologists, 2021. Topical corticosteroids for eczema. [online] Available at: http://www.bad.org.uk/shared/get-file.ashx?id=65&itemtype=document [Accessed 12 October 2023].
4. National Eczema Association, 2021. Understanding topical steroids and other topical treatments for eczema. [online] Available at: https://nationaleczema.org/eczema/treatment/topicals/ [Accessed 12 October 2023].
5. National Eczema Association, 2021. Bleach baths for eczema. [online] Available at: https://nationaleczema.org/eczema/treatment/bleach-baths/ [Accessed 12 October 2023].
6. Medicines and Healthcare products Regulatory Agency, 2021. Dupilumab (Dupixent) for treating moderate to severe atopic dermatitis in children aged 6 to 11 years. [online] Available at: https://www.nice.org.uk/guidance/indevelopment/gid-ta10585 [Accessed 12 October 2023].
7. National Eczema Association, 2021. Systemic medications for eczema. [online] Available at: https://nationaleczema.org/eczema/treatment/systemics/ [Accessed 12 October 2023].
8. Practitioner Development UK, 2021. Understanding and Applying Emollients in Paediatric Eczema. [online] Available at: https://www.pduk.net/ [Accessed 12 October 2023].