IMPORTANT NOTE:
The information on this page is ONLY to be used when provided to your child or teen as part of a treatment plan from your CPCMG health care team.
General
WHAT IS ATOPIC DERMATITIS?
Atopic dermatitis (also called eczema) is a condition where the skin is dry, red, and itchy. The main function of the skin is to provide a barrier from the environment. It is also the first defense of the immune system.
In atopic dermatitis, the skin barrier is decreased, and the skin is easily irritated. Also, the skin's immune system is different. If there are increased allergic-type cells in the skin, it may become red and "hyper-excitable." This leads to itching and a rash.
WHY DO PEOPLE GET ATOPIC DERMATITIS?
There is no single answer because many factors are involved. It is likely a combination of genetic makeup, environmental triggers, and exposures. Excessive drying or sweating of the skin, irritating soaps, dust mites, and pet dander are some of the more common triggers. There is no blood test that can be done to confirm this diagnosis. The symptoms and appearance of the skin is usually sufficient for a diagnosis. Rarely, a skin biopsy may be helpful. Many children outgrow atopic dermatitis or get better; however, many continue to have sensitive skin into adulthood.
Asthma and hay fever are seen in many patients with atopic dermatitis, however, asthma flares do not always occur at the same time as skin flares.
SKINCARE SUGGESTIONS FOR ALL PEOPLE WITH ATOPIC DERMATITIS
- Bathe daily or every other day. Keep it brief (10 minutes or less). Keep the soap gentle (mild, fragrance-free).
- Do not use bubble bath.
- Pat the skin dry with a towel. Immediately apply medication or a moisturizer while the skin is still slightly damp. Medicated creams and ointments should always be applied before moisturizers.
- Moisturize generously after bathing with a fragrance-free cream or ointment.
- Avoid common triggers that cause itching: fragrances, dust, grass, weeds, cigarette smoke, wool, polyester, and household cleaning agents.
Examples of recommended moisturizers: Aquaphor Healing Ointment, Vaseline (petrolatum), Vaniply, CeraVe Moisturizing Cream, Cetaphil Moisturizing Cream, Vanicream Moisturizing Skin Cream.
See this complete list of cleansers and moisturizers approved by the National Eczema Association (NEA).
Preventing Atopic Dermatitis Flares
Select a topic to learn more.
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Flares
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Triggers
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Food Allergies
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Atopic Dermatitis Triggers
Triggers are different for different people. The most common triggers are:
- Heat and sweat for some individuals, cold weather for others.
- House dust mites; pet fur.
- Wool; synthetic fabrics like nylon; dyed fabrics.
- Tobacco smoke
- Fragrances in shampoos, soaps, lotions, laundry detergents, and fabric softeners.
- Saliva or prolonged exposure to water.
Food Allergies and Atopic Dermatitis
This is a very controversial topic, as many believe that food allergies are responsible for skin flares. In some cases, specific foods may cause worsening of atopic dermatitis; however, this occurs in a minority of cases and usually happens within a few hours of ingestion. While food allergy is more common in children with eczema, foods are specific triggers for flares in only a small percentage of children. If you notice that the skin flares after certain foods, you can see if eliminating one food at a time makes a difference, as long as your child can still enjoy a well-balanced diet.
There are blood and skin tests that can check for allergies, but they are often positive in children who have no problems eating those foods. Therefore it is important that you work with your allergist and dermatologist to determine which foods are relevant and causing true symptoms. Extreme food elimination diets without the guidance of your health care team may even result in the worsening of a skin rash due to malnutrition and avoidance of essential nutrients.
Preventing Flares
The first step is to maintain the skin's barrier function. Keep the skin well moisturized. Avoid irritants and triggers. Use prescribed medicine when there are red or rough areas, to help the skin to return to normal as quickly as possible. Try to limit scratching.
If everything is being done as it should, why does the rash keep flaring?
If you keep the skin well moisturized and avoid coming in contact with things you know irritate your child's skin, there will be fewer flares. However, some flares of atopic dermatitis are beyond your control. You should work with your health care team to come up with a plan that minimizes flares while minimizing the long-term use of medications that suppress the immune system.
Treatment
Treatments are aimed at minimizing exposure to irritating factors and decreasing skin inflammation.
There are many different treatment options, which depend on your child's rash, its location, and its severity. Topical treatments include corticosteroids and steroid-like creams such as tacrolimus, pimecrolimus, and crisaborole which do not thin the skin. Please read below regarding the risks and benefits of all of these creams.
Occasionally bacterial or viral infections can occur that flare the skin and require oral and/or topical antibiotics or antivirals. In some cases bleach baths (see section further down), 2-3 times weekly can be helpful to prevent recurrent infection.
For severe disease, strong oral medications such as corticosteroids, methotrexate, cyclosporine, or injections such as dupilumab may be needed. These medications require close monitoring and follow-up. You should discuss the risks, benefits, and alternatives of these medications with your health care team to come up with the best treatment plan for your child.
TREATMENT RECOMMENDATIONS
(CLICK AN ITEM FOR DETAILS)
Use moisturizer all over the entire body at least twice a day.
This keeps the skin moisturized to restore the barrier function. Find a cream or ointment that your child likes. The thicker the moisturizer, generally the better barrier it provides. Ointments often moisturize better than creams, and creams work better than lotions. Lotions are more useful during the summer when thick greasy ointments are uncomfortable. The moisturizer provides a seal holding water in the skin. You may bathe your child in warm - not hot - water, for short periods of time (no more than 15 minutes) once a day if they like. Lightly pat your child dry with a towel and, while the skin is still damp, apply a moisturizer from head to toe. If your child is using a medicated cream, apply that BEFORE you apply the moisturizer.
DeleteApply the prescription medication to the red, rough areas on the skin.
Put the medication on your fingers and gently rub it into the areas. Usually, the medicine will help an area within a few days. Try to put the medicine on for two days after you have noticed that the redness is no longer present; this will help the redness from returning. The severity of the rash and the strength and usage of the medication will determine how quickly you see improvement.
It is important that you do not overuse steroid creams, and if you notice a thin, shiny appearance on the skin or broken blood vessels, you should stop using the cream and consult your health care team regarding possible overuse. The face, armpits, and groin have particularly thin and sensitive skin and are therefore most at risk for bad results if steroids are over-used in these sites.
DeleteAvoid Triggers
Some children have specific things that trigger itching and rashes, while others may have none that can be identified. It may require a little bit of trial and error to see what applies to your child. Also, triggers can change over time for your child. The most common triggers are listed above. Try to use laundry detergents, soaps, and shampoos that are fragrance-free. You may find it helpful to double-rinse your clothes.
Some children are sensitive to house dust mites and they may benefit from a plastic mattress wrap. While food allergy is more common in children with eczema, foods are specific triggers for flares in only a small percentage of children. If you notice that the skin flares after certain foods, you can see if eliminating one food at a time makes a difference, as long as your child can still enjoy a well-balanced diet.
DeleteConsider using a medication by mouth to help control the itching.
Scratching only makes the skin more reactive and the barrier function even more disrupted. It can cause both children and their parents to lose sleep! There are different types of anti-itch medications. Some cause more drowsiness than others. Both types are acceptable depending on your child and your preference.
DeleteInformation about prescription creams and ointments
Corticosteroid creams and ointments (generally things with "-one" on the end of the name):
The strength of the cream or ointment depends on the name of the active ingredient. The numbers at the end do not indicate the relative strength. Thus triamcinolone 0.1% ointment, considered a mid-strength corticosteroid, is much stronger than hydrocortisone 1% even though the number following the name is much lower. Topical corticosteroids are very effective in treating atopic dermatitis. When used in the manner prescribed (to rashy areas of skin and for no more than a few weeks at a time to any one area) they are very safe.
Topical non-steroid creams and ointments (immunomodulators)
These creams and ointments are also called topical calcineurin inhibitors (TCIs). These include Protopic ointment and Elidel cream. They help decrease itching and redness in the skin. They are not as strong as most steroid creams; however, they do not thin the skin when overused. They are generally used as second-line medications, though they may be used alone or together with topical steroids. In sensitive areas such as the face, underarms, or groin, they are often recommended. They can sting inflamed skin but are generally well tolerated once the skin is healing.
The FDA placed a warning on both Elidel and Protopic in 2006 based on animal studies using the medications. Some animals developed skin cancer and lymphoma. Subsequently, the FDA released a statement that there is no causal relationship between the two medications and cancer. Because of this concern, there are ongoing studies to evaluate this relationship in humans. So far, there are studies that support the safety of these medications.
Crisaborole 2% ointment is a new non-steroidal medication that decreases skin inflammation in atopic dermatitis. It appears to be safe and generally effective when used twice daily. The main side effect is stinging and burning at the site of application, which is generally mild. Rarely, patients have allergies to this medication so stop using it and contact your health care team right away if you notice severe itching, swelling, or redness, as this may indicate an allergy.
DeleteBleach baths for bacterial overgrowth
This information is only to be followed if your child's care team recommended bleach baths for recurrent infections with Staphylococcus aureus bacteria.
Itching, scratching, and the immune dysregulation of atopic dermatitis, lead to an increased risk of infection from skin bacteria, especially Staphylococcus aureus. A good way to reduce the amount of bacteria on the skin is by using chlorinated water in a dilute "bleach bath" two or three times a week (ie, Tues + Thurs, or Mon + Wed + Fri). Here are our simple recommendations:
1. Put 1/4 cup of common bleach (for example, Clorox) into an empty bathtub.
2. Add lukewarm water to fill the tub one-half full. Be certain that the bleach is diluted completely in the water - much like the water in a chlorinated swimming pool!
3. Soak in the chlorinated water for about 10 minutes.
4. If you notice that dryness and/or irritation occur after the soaking stage, thoroughly rinse the skin clear with lukewarm fresh water at the end of the bleach bath.
5. As soon as the bath is over, pat dry. Do not rub dry as this is the same as scratching!
6. Immediately apply any prescribed medication and emollient.
7. Repeat bleach baths 2 to 3 times per week or as prescribed by the care team.
- NEVER use undiluted bleach directly on the skin. Even a diluted bleach bath can potentially cause dryness and/or irritation.
- Do not use bleach baths if there are any breaks or open areas in the skin.
- Do not use bleach baths for patients with a known contact allergy to chlorine.
Medications for Treatment
Steroid Creams & Ointments
Select the steroid cream or ointment prescribed by your care team for use on THE BODY.
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Hydrocortisone ONLY
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Hydrocortisone + Derma-Smoothe
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Hydrocortisone + Triamcinolone
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Hydrocortisone + Fluocinonide
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Hydrocortisone ONLY
Getting your child’s eczema flare under control
When the FACE is flared:
Apply Hydrocortisone 2.5% to the affected areas 2 times a day for 7 days then once a day for up 5 days or until clear. Once improved, it is safe to use Hydrocortisone 2.5% up to twice a week to trouble spots.
When the BODY is flared:
Weeks 1-2: Apply Hydrocortisone 2.5% ointment to the affected area twice per day.
Week 3: Apply Hydrocortisone 2.5% ointment to the affected area once per day.
Week 4 and until the eczema is clear and well controlled: Apply Hydrocortisone 2.5% ointment to the “trouble spots” two days per week.
GENERAL SUGGESTIONS FOR MEDICATED CREAMS AND OINTMENTS:
If an area totally clears up, treat 2 to 3 days beyond clearing, then decrease the frequency to that area.
If your child’s eczema flares, restart the treatment.
Steroids that go on your skin do not usually have serious side effects.
Eczema can cause lightening of the skin because of the inflammation in the skin. This is only very rarely caused by the overuse of topical steroids. Appropriate usage usually results in a quicker improvement in color changes triggered by eczema
Skin thinning from topical steroids can occur if medicines are used continuously for weeks to months, and is usually avoided if they are used only a few times a week. If thinning occurs, it usually recovers in weeks to months if you stop the use of the steroids.
Please bring your medications with you to your next appointment.
Milk of Magnesia
Your child’s maintenance regimen is MILK OF MAGNESIA to be given 1-2 time(s) per day. If your doctor prescribed a “cleanout”, start this after your cleanout.
Take medications as instructed. Your child’s daily dose may be titrated up or down for a goal of stools being soft, “pudding consistency”.
Scheduled toilet time: Get kids into the habit of going to the bathroom regularly. Have your child sit on the toilet for at 10 minutes at about the same time each day, ideally, after a meal. Sitting on the toilet after meals is particularly helpful because your body has a natural reflex in which the bowels contract when there is food in the stomach, leading to the urge to stool.
Body positioning on the toilet: Place a stool under your child’s feet when he or she is sitting on the toilet, so that the feet are not dangling and the knees are bent. The squatting position is ideal for defecation as it relaxes the pelvic muscles, allowing gravity to do most of the work.
Fluids: Drinking enough water and other liquids helps stools move more easily through the intestines. The amount of fluids kids need will vary according to weight and age. School-age kids need at least 3 to 4 glasses of water each day. Teenagers need 8 glasses of water each day.
Diet: Foods with fiber (such as fruits, vegetables, and whole-grain bread) can help with constipation. Fiber can't be digested, so it helps clean out the intestines by moving the bowels along. Fiber doesn't have to be a turn-off for kids — try apples, pears, beans, oatmeal, oranges, ripe bananas, whole-grains breads, and popcorn. Adding flax meal or bran to homemade fruit smoothies is another way to slip fiber into a child's diet. A diet full of fatty, sugary, or starchy foods can slow the bowels down.
Exercise: Physical activity nudges the bowels into action, so encourage your kids to get plenty of exercise – school age kids and teens should get at least 60minutes of vigorous activity daily. It can be as simple as playing catch, riding bikes, or shooting a few hoops.
Develop a regular meal schedule: Since eating is a natural stimulant for the bowels, regular meals may help kids develop routine bowel habits. If necessary, schedule breakfast a little earlier to give your child a chance for a relaxed visit to the bathroom before school.
Follow up! We would like to see you back in the office, usually no longer than 3 months from now to check to see how you are doing.
Miralax
Your child’s maintenance regimen is MIRALAX to be given ONCE per day. If your doctor prescribed a “cleanout”, start this after your cleanout.
Take medications as instructed. Your child’s daily dose may be titrated up or down for a goal of stools being soft, “pudding consistency”.
Scheduled toilet time: Get kids into the habit of going to the bathroom regularly. Have your child sit on the toilet for at 10 minutes at about the same time each day, ideally, after a meal. Sitting on the toilet after meals is particularly helpful because your body has a natural reflex in which the bowels contract when there is food in the stomach, leading to the urge to stool.
Body positioning on the toilet: Place a stool under your child’s feet when he or she is sitting on the toilet, so that the feet are not dangling and the knees are bent. The squatting position is ideal for defecation as it relaxes the pelvic muscles, allowing gravity to do most of the work.
Fluids: Drinking enough water and other liquids helps stools move more easily through the intestines. The amount of fluids kids need will vary according to weight and age. School-age kids need at least 3 to 4 glasses of water each day. Teenagers need 8 glasses of water each day.
Diet: Foods with fiber (such as fruits, vegetables, and whole-grain bread) can help with constipation. Fiber can't be digested, so it helps clean out the intestines by moving the bowels along. Fiber doesn't have to be a turn-off for kids — try apples, pears, beans, oatmeal, oranges, ripe bananas, whole-grains breads, and popcorn. Adding flax meal or bran to homemade fruit smoothies is another way to slip fiber into a child's diet. A diet full of fatty, sugary, or starchy foods can slow the bowels down.
Exercise: Physical activity nudges the bowels into action, so encourage your kids to get plenty of exercise – school age kids and teens should get at least 60minutes of vigorous activity daily. It can be as simple as playing catch, riding bikes, or shooting a few hoops.
Develop a regular meal schedule: Since eating is a natural stimulant for the bowels, regular meals may help kids develop routine bowel habits. If necessary, schedule breakfast a little earlier to give your child a chance for a relaxed visit to the bathroom before school.
Follow up! We would like to see you back in the office, usually no longer than 3 months from now to check to see how you are doing.
Mineral Oil + ExLax
Your child’s maintenance regimen is MINERAL OIL to be given once at bedtime as directed. ALSO, give Ex-Lax Chocolate tab nightly as directed. If your doctor prescribed a “cleanout”, start this after your cleanout.
Take medications as instructed. Your child’s daily dose may be titrated up or down for a goal of stools being soft, “pudding consistency”.
Scheduled toilet time: Get kids into the habit of going to the bathroom regularly. Have your child sit on the toilet for at 10 minutes at about the same time each day, ideally, after a meal. Sitting on the toilet after meals is particularly helpful because your body has a natural reflex in which the bowels contract when there is food in the stomach, leading to the urge to stool.
Body positioning on the toilet: Place a stool under your child’s feet when he or she is sitting on the toilet, so that the feet are not dangling and the knees are bent. The squatting position is ideal for defecation as it relaxes the pelvic muscles, allowing gravity to do most of the work.
Fluids: Drinking enough water and other liquids helps stools move more easily through the intestines. The amount of fluids kids need will vary according to weight and age. School-age kids need at least 3 to 4 glasses of water each day. Teenagers need 8 glasses of water each day.
Diet: Foods with fiber (such as fruits, vegetables, and whole-grain bread) can help with constipation. Fiber can't be digested, so it helps clean out the intestines by moving the bowels along. Fiber doesn't have to be a turn-off for kids — try apples, pears, beans, oatmeal, oranges, ripe bananas, whole-grains breads, and popcorn. Adding flax meal or bran to homemade fruit smoothies is another way to slip fiber into a child's diet. A diet full of fatty, sugary, or starchy foods can slow the bowels down.
Exercise: Physical activity nudges the bowels into action, so encourage your kids to get plenty of exercise – school age kids and teens should get at least 60minutes of vigorous activity daily. It can be as simple as playing catch, riding bikes, or shooting a few hoops.
Develop a regular meal schedule: Since eating is a natural stimulant for the bowels, regular meals may help kids develop routine bowel habits. If necessary, schedule breakfast a little earlier to give your child a chance for a relaxed visit to the bathroom before school.
Follow up! We would like to see you back in the office, usually no longer than 3 months from now to check to see how you are doing.
Hydrocortisone + Flucinolone (Derma-Smoothe)
Getting your child’s eczema flare under control
When the FACE is flared:
- Apply Hydrocortisone 2.5% to the affected areas twice per day for 7 days then once per day for up 5 days or until clear.
- Once improved, it is safe to use Hydrocortisone 2.5% up to twice per week to trouble spots.
When the BODY is flared:
Weeks 1-2: Apply Derma-smoothe (fluocinolone acetonide oil) 0.01% to the affected area twice per day.
Week 3: Apply Derma-smoothe (fluocinolone acetonide oil) 0.01% to the affected area once per day.
Week 4 and until the eczema is clear and well-controlled: Apply Derma-smoothe (fluocinolone acetonide oil) 0.01% to the “trouble spots” two days per week.
Remember: Do not use Derma-smoothe (fluocinolone acetonide oil) 0.01% on the face or groin.
GENERAL SUGGESTIONS:
If an area totally clears up, treat 2 to 3 days beyond clearing, then decrease the frequency to that area.
If your child’s eczema flares, restart the treatment.
Steroids that go on your skin do not usually have serious side effects.
Eczema can cause lightening of the skin because of the inflammation in the skin. This is only very rarely caused by the overuse of topical steroids. Appropriate usage usually results in a quicker improvement in color changes triggered by eczema
Skin thinning from topical steroids can occur if medicines are used continuously for weeks to months, and is usually avoided if they are used only a few times a week. If thinning occurs, it usually recovers in weeks to months if you stop the use of the steroids.
Please bring your medications with you to your next appointment.
Suggestions for general skin care:
1. Bathe daily or every other day. Keep it brief (10 minutes or less). Keep the soap gentle (mild, fragrance-free).
2. Do not use bubble bath.
3. Pat the skin dry with a towel. Immediately apply medication or a moisturizer while the skin is still slightly damp. Topical medications should always be applied before moisturizers.
4. Moisturize generously after bathing with a fragrance-free cream or ointment.
Examples: Aquaphor Healing Ointment, Vaseline (petrolatum), Vaniply, CeraVe Moisturizing Cream, Cetaphil Moisturizing Cream, Vanicream Moisturizing Skin Cream
A complete list of cleansers and moisturizers approved by the National Eczema Association (NEA) can be found at: nationaleczema.org.
5. Avoid common triggers that cause itching: fragrances, dust, grass, weeds, cigarette smoke, wool, polyester, and household cleaning agents.
Getting your child’s eczema flare under control
When the FACE is flared:
- Apply Hydrocortisone 2.5% to the affected areas twice per day for 7 days then once per day for up 5 days or until clear.
- Once improved, it is safe to use Hydrocortisone 2.5% up to twice per week to trouble spots.
When the BODY is flared:
Week 1-2: Apply Triamcinolone 0.1 % to the affected area twice per day.
Week 3: Apply Triamcinolone 0.1 % to the affected area once per day.
Week 4 and until the eczema is clear and well-controlled: Apply Triamcinolone 0.1 % to the “trouble spots” two days per week.
Remember: Do not use Triamcinolone 0.1% on the face or groin.
GENERAL SUGGESTIONS:
If an area totally clears up, treat 2 to 3 days beyond clearing, then decrease the frequency to that area.
If your child’s eczema flares, restart the treatment.
Steroids that go on your skin do not usually have serious side effects.
Eczema can cause lightening of the skin because of the inflammation in the skin. This is only very rarely caused by the overuse of topical steroids. Appropriate usage usually results in a quicker improvement in color changes triggered by eczema
Skin thinning from topical steroids can occur if medicines are used continuously for weeks to months, and is usually avoided if they are used only a few times a week. If thinning occurs, it usually recovers in weeks to months if you stop the use of the steroids.
Please bring your medications with you to your next appointment.
Suggestions for general skin care:
1. Bathe daily or every other day. Keep it brief (10 minutes or less). Keep the soap gentle (mild, fragrance-free).
2. Do not use bubble bath.
3. Pat the skin dry with a towel. Immediately apply medication or a moisturizer while the skin is still slightly damp. Topical medications should always be applied before moisturizers.
4. Moisturize generously after bathing with a fragrance-free cream or ointment.
Examples: Aquaphor Healing Ointment, Vaseline (petrolatum), Vaniply, CeraVe Moisturizing Cream, Cetaphil Moisturizing Cream, Vanicream Moisturizing Skin Cream
A complete list of cleansers and moisturizers approved by the National Eczema Association (NEA) can be found at: nationaleczema.org.
5. Avoid common triggers that cause itching: fragrances, dust, grass, weeds, cigarette smoke, wool, polyester, and household cleaning agents.
Getting your child’s eczema flare under control
When the FACE is flared:
- Apply Hydrocortisone 2.5% to the affected areas twice per day for 7 days then once a day for up 5 days or until clear.
- Once improved, it is safe to use Hydrocortisone 2.5% up to twice per week to trouble spots.
When the BODY is flared:
Weeks 1-2: Apply Fluocinonide 0.05% to the affected area twice per day.
Week 3: Apply Fluocinonide 0.05% to the affected area once per day.
Week 4 and until the eczema is clear and well-controlled: Apply Fluocinonide 0.05% to the “trouble spots” two days per week.
Remember: Do not use Fluocinonide 0.05% on the face or groin.
GENERAL SUGGESTIONS:
If an area totally clears up, treat 2 to 3 days beyond clearing, then decrease the frequency to that area.
If your child’s eczema flares, restart the treatment.
Steroids that go on your skin do not usually have serious side effects.
Eczema can cause lightening of the skin because of the inflammation in the skin. This is only very rarely caused by the overuse of topical steroids. Appropriate usage usually results in a quicker improvement in color changes triggered by eczema
Skin thinning from topical steroids can occur if medicines are used continuously for weeks to months, and is usually avoided if they are used only a few times a week. If thinning occurs, it usually recovers in weeks to months if you stop use of the steroids.
Please bring your medications with you to your next appointment.
Suggestions for general skin care:
1. Bathe daily or every other day. Keep it brief (10 minutes or less). Keep the soap gentle (mild, fragrance-free).
2. Do not use bubble bath.
3. Pat the skin dry with a towel. Immediately apply medication or a moisturizer while the skin is still slightly damp. Topical medications should always be applied before moisturizers.
4. Moisturize generously after bathing with a fragrance-free cream or ointment.
Examples: Aquaphor Healing Ointment, Vaseline (petrolatum), Vaniply, CeraVe Moisturizing Cream, Cetaphil Moisturizing Cream, Vanicream Moisturizing Skin Cream
A complete list of cleansers and moisturizers approved by the National Eczema Association (NEA) can be found at: http://www.nationaleczema.org.
5. Avoid common triggers that cause itching: fragrances, dust, grass, weeds, cigarette smoke, wool, polyester, household cleaning agents.
Non-Steroid Creams & Ointments
Select the NON-steroid cream or ointment prescribed by your care team.
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Elidel
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Eucrisa
-
Protopic
- Add Button
Pimecrolimus (Elidel)
Getting your child’s eczema flare under control
When the FACE is flared:
Apply Pimecrolimus (Elidel) 1% ointment to the affected areas 2 times per day for 7 days then once per day for up 5 days or until clear.
Once improved, it is safe to use Pimecrolimus (Elidel) 1% ointment up to twice a week to trouble spots.
When the BODY is flared:
Weeks 1-2: Apply Pimecrolimus (Elidel) 1% ointment to the affected area twice per day.
Week 3: Apply Pimecrolimus (Elidel) 1% ointment to the affected area once per day.
Week 4 and until the eczema is clear and well-controlled: Apply Pimecrolimus (Elidel) 1% ointment to the “trouble spots” two days a week.
Remember: Do not use Pimecrolimus (Elidel) 1% ointment on the groin.
Pimecrolimus 1% ointment is a non-steroidal medication that decreases skin inflammation in atopic dermatitis (eczema). You will get sunburned more easily when using these medications; always use good sun protection (wear SPF > 30 every morning, re-apply every 2 hours if outdoors, and wear long sleeves). The main side effect is stinging and burning at the site of application, which is generally mild. Rarely, patients have allergies to this medication so stop using it and contact us right away if you notice severe itching, swelling, or redness, as this may indicate an allergy. Extremely rare cases of skin cancer and lymphoma have been reported in patients with tacrolimus, which is a cousin drug of pimecrolimus, but there is no proof that tacrolimus caused these cancers.
- GENERAL SUGGESTIONS:
- If an area totally clears up, treat 2 to 3 days beyond clearing, then decrease the frequency to that area.
- If your child’s eczema flares, restart the treatment.
- Steroids that go on your skin do not usually have serious side effects.
- Eczema can cause lightening of the skin because of the inflammation in the skin. This is only very rarely caused by the overuse of topical steroids. Appropriate usage usually results in a quicker improvement in color changes triggered by eczema
- Skin thinning from topical steroids can occur if medicines are used continuously for weeks to months, and is usually avoided if they are used only a few times a week. If thinning occurs, it usually recovers in weeks to months if you stop the use of the steroids.
- Bring your medications with you to your next appointment.
Crisaborole (Eucrisa)
Getting your child’s eczema flare under control
When the FACE is flared:
Apply Crisaborole 2% ointment (Eucrisa) to the affected areas 2 times a day for 7 days then once a day for up 5 days or until clear. Once improved, it is safe to use Crisaborole 2% ointment (Eucrisa) up to twice a week to trouble spots.
When the BODY is flared:
Weeks 1-2: Apply Crisaborole 2% ointment (Eucrisa) to the affected area twice per day.
Week 3: Apply Crisaborole 2% ointment (Eucrisa) to the affected area once per day.
Week 4 and until the eczema is clear and well-controlled: Apply Crisaborole 2% ointment (Eucrisa) to the “trouble spots” two days per week.
Remember: Do not use Crisaborole 2% ointment (Eucrisa) on the groin.
- Crisaborole 2% ointment is a new non-steroidal medication that decreases skin inflammation in atopic dermatitis (eczema). It is a new drug, so further studies are needed to fully understand its long-term effects. However, it appeared to be safe and effective in a clinical trial where it was used every day, twice a day, for 28 days. The main side effect is stinging and burning at the site of application, which is generally mild. Rarely, patients have allergies to this medication so stop using it and contact us right away if you notice severe itching, swelling, or redness, as this may indicate an allergy.
GENERAL SUGGESTIONS:
- If an area totally clears up, treat 2 to 3 days beyond clearing, then decrease the frequency to that area.
- If your child’s eczema flares, restart the treatment.
- Steroids that go on your skin do not usually have serious side effects.
- Eczema can cause lightening of the skin because of the inflammation in the skin. This is only very rarely caused by the overuse of topical steroids. Appropriate usage usually results in a quicker improvement in color changes triggered by eczema
- Skin thinning from topical steroids can occur if medicines are used continuously for weeks to months, and is usually avoided if they are used only a few times a week. If thinning occurs, it usually recovers in weeks to months if you stop the use of the steroids.
- Bring your medications with you to your next appointment.
Tacrolimus (Protopic)
Getting your child’s eczema flare under control
When the FACE is flared:
Apply Tacrolimus (Protopic) ointment to the affected areas twice per day for 7 days then once a day for up 5 days or until clear.
Once improved, it is safe to use Tacrolimus (Protopic) ointment up to twice per week to trouble spots.
When the BODY is flared:
Weeks 1-2: Apply Tacrolimus (Protopic) 0.03% ointment to the affected area twice per day.
Week 3: Apply Tacrolimus (Protopic) 0.03% to the affected area once per day.
Week 4 and until the eczema is clear and well-controlled: Apply Tacrolimus (Protopic) 0.03% ointment to the “trouble spots” two days per week.
Remember: Do not use Tacrolimus (Protopic) 0.03% ointment on the groin.
Tacrolimus ointment is a non-steroidal medication that decreases skin inflammation in atopic dermatitis (eczema). You will get sunburned more easily when using these medications; always use good sun protection (wear SPF > 30 every morning, re-apply every 2 hours if outdoors, and wear long sleeves). The main side effect is stinging and burning at the site of application, which is generally mild. Rarely, patients have allergies to this medication so stop using it and contact us right away if you notice severe itching, swelling, or redness, as this may indicate an allergy. Extremely rare cases of skin cancer and lymphoma have been reported in patients with tacrolimus, but there is no proof that tacrolimus caused these cancers.
GENERAL SUGGESTIONS:
- If an area totally clears up, treat 2 to 3 days beyond clearing, then decrease the frequency to that area.
- If your child’s eczema flares, restart the treatment.
- Steroids that go on your skin do not usually have serious side effects.
- Eczema can cause lightening of the skin because of the inflammation in the skin. This is only very rarely caused by the overuse of topical steroids. Appropriate usage usually results in a quicker improvement in color changes triggered by eczema
- Skin thinning from topical steroids can occur if medicines are used continuously for weeks to months, and is usually avoided if they are used only a few times a week. If thinning occurs, it usually recovers in weeks to months if you stop the use of the steroids.
- Bring your medications with you to your next appointment.
Combinations of Steroid and Non-Steroid Ointments
For some patients, your care team will prescribe a steroid ointment to get a flare under control, followed by a non-steroid ointment to maintain clear skin. Please follow these instructions:
DURING FLARE (when eczema patches are red, itchy, and "angry"):
FACE + GROIN: Apply hydrocortisone 2.5% ointment to affected areas of the face and groin twice daily for up to three days beyond clearance.
BODY: Apply triamcinolone 0.1% ointment liberally to affected areas of the body (NOT face/groin) twice daily for up to three days beyond clearance.
AFTER FLARE (when eczema patches are completely resolved):
Change to the non-steroid ointment (Elidel, Eucrisa, or Protopic) prescribed by your care team and apply liberally to the affected areas (EXCEPT groin) twice per day for several weeks then slowly decrease to several times per week for long-term control.
Other Medications
Select a medication for information.
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Scalp Medications
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Hydroxyzine
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Loratadine/Cetirizine
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Miralax (Gentle)
Cleanout:
1. Your doctor MAY recommend giving your child an enema on the first day of “cleanout”
A. Children 1-2 years old: give Saline enema ONCE as prescribed
B. Children 2-11yo: give Saline enema 60 ml ONCE; repeat if no bowel movement in 30 mins
C. Children older than 11yo: give Saline enema 133 ml ONCE; repeat if no bowel movement in 30 mins
2. Miralax: each capful to be mixed in 8 oz of clear fluid. Take as instructed by your doctor for 3 days, then continue at maintenance dosing (as below)
3. Glycerin rectal suppository: Use glycerin suppository daily as needed for no stool in 12 hours
What to Expect During the Cleanout
• A cleanout is a process where your child takes stool softeners by mouth and passes all of the stool present in the large intestine (also called the colon).
• Cleanouts can take 1-4 days depending on the method chosen
• It is best to do the cleanout on a weekend when you and your child will be home
• Your child's stools will probably change during this process and go from: Solid → liquid or mushy with some solid chunks → liquid and translucent (like tea) After the cleanout if stool is not liquid and translucent then contact your doctor for further instructions.
• Abdominal cramping and nausea are normal and expected during the cleanout
Please call clinic if:
- Your child has severe abdominal pain
- Your child is vomiting and is unable to drink fluids
- There is blood in the stool
- Other questions or concerns
Miralax (Aggressive)
Cleanout:
1. Enema. Your doctor MAY recommend giving your child an enema on the first day of “cleanout”
A. Children 1-2 years old: give Saline enema ONCE as prescribed
B. Children 2-11yo: give Saline enema 30-60ml ONCE; repeat if no bowel movement in 30mins
C. Children older than 11yo: give Saline enema 60-150ml ONCE; repeat if no bowel movement in 30mins
2.Bisacodyl (Doculax)
A. Take once as directed on day one of cleanout
3.Miralax (polyethylene glycol)
A. Take as instructed by your doctor once or twice daily for 3 days, then continue at maintenance dosing (as below)
4. Glycerin rectal suppository- Use glycerin suppository daily as needed for no stool in 12 hours
What to Expect During the Cleanout
• A cleanout is a process where your child takes stool softeners by mouth and passes all of the stool present in the large intestine (also called the colon).
• Cleanouts can take 1-4 days depending on the method chosen
• It is best to do the cleanout on a weekend when you and your child will be home
• Your child's stools will probably change during this process and go from: Solid → liquid or mushy with some solid chunks → liquid and translucent (like tea) After the cleanout if stool is not liquid and translucent then contact your doctor for further instructions.
• Abdominal cramping and nausea are normal and expected during the cleanout
Please contact your healthcare team if:
- your child has severe abdominal pain
- your child is vomiting and is unable to drink fluids
- there is blood in the stool
- other questions or concerns
Miralax (Aggressive)
Cleanout:
1. Enema. Your doctor MAY recommend giving your child an enema on the first day of “cleanout”
A. Children 1-2 years old: give Saline enema ONCE as prescribed
B. Children 2-11yo: give Saline enema 30-60ml ONCE; repeat if no bowel movement in 30mins
C. Children older than 11yo: give Saline enema 60-150ml ONCE; repeat if no bowel movement in 30mins
2.Bisacodyl (Doculax)
A. Take once as directed on day one of cleanout
3.Miralax (polyethylene glycol)
A. Take as instructed by your doctor once or twice daily for 3 days, then continue at maintenance dosing (as below)
4. Glycerin rectal suppository- Use glycerin suppository daily as needed for no stool in 12 hours
What to Expect During the Cleanout
• A cleanout is a process where your child takes stool softeners by mouth and passes all of the stool present in the large intestine (also called the colon).
• Cleanouts can take 1-4 days depending on the method chosen
• It is best to do the cleanout on a weekend when you and your child will be home
• Your child's stools will probably change during this process and go from: Solid → liquid or mushy with some solid chunks → liquid and translucent (like tea) After the cleanout if stool is not liquid and translucent then contact your doctor for further instructions.
• Abdominal cramping and nausea are normal and expected during the cleanout
Please contact your healthcare team if:
- your child has severe abdominal pain
- your child is vomiting and is unable to drink fluids
- there is blood in the stool
- other questions or concerns
Scalp Medications
- Fluocinolone Oil (Derma-Smoothe) OR
- Fluocinolone Solution (Synalar) OR
- Fluocinonide Solution (Lidex)
Apply every night for one week, then decrease the frequency to three times a week for one week.
- Massage into wet or dampened hair/scalp. Cover with a shower cap.
- Leave on overnight (or for at least 4 hours).
- Remove by washing hair with shampoo and rinsing thoroughly.
- Massage into wet or dampened hair/scalp. Cover with a shower cap.
- Leave on overnight (or for at least 4 hours).
- Remove by washing hair with shampoo and rinsing thoroughly.
Hydroxyzine
If hydroxyzine is prescribed for your child, give the dose at bedtime to prevent itchiness during sleep. This may be given up to every 8 hours, but since it causes sleepiness this isn't typically recommended.
Loratadine/Cetirizine
If loratadine (Claritin) or cetirizine (Zyrtec) is prescribed for your child, give the dose in the morning to prevent daytime itchiness.
Additional Treatment Resources
- There is great information available on the Rady Children's Hospital Eczema Center website.
- Here's an educational PowerPoint.