Skip to main content
SpringerLink
Log in

Treatment of Childhood Eczema

  • Therapy In Practice
  • Published:
Pediatric Drugs Aims and scope Submit manuscript

Abstract

Eczema in childhood is almost always atopic eczema, a common disease with huge impact on the quality of life of the child and family. Although atopic eczema constitutes part of the atopic syndrome, avoidance of allergens is never enough for disease control.

Treatment of eczema in childhood has the same components as in adults. Emollients constitute the preventive background therapy in all stages of eczema, and topical corticosteroids are still the mainstay of treatment. Infectious exacerbation may require the use of a short course of topical or systemic antimicrobials. UV phototherapy should be considered as an adjunctive treatment to assist topical corticosteroids after an acute exacerbation of the disease. Cyclosporine can also be used in the treatment of childhood eczema in severe cases. Maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house-dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, and topical coal tar are other temporarily used treatment modalities, without, however, firm evidence of efficacy from proper controlled trials. Calcineurin inhibitors constitute a new generation of drugs for both adult and childhood eczema already marketed in some countries. It is postulated that they will replace topical corticosteroids as first-line treatment of eczema.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1

Similar content being viewed by others

References

  1. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol 1980; 92: 22–47

    Google Scholar 

  2. European Task Force on Atopic Dermatitis. Severity scoring of atopic dermatitis: the SCORAD index. Consensus report of the European Task Force on Atopic Dermatitis. Dermatology 1993; 186: 23–31

    Article  Google Scholar 

  3. Berth-Jones J. Six area, six sign atopic dermatitis (SASSAD) severity score: a simple system for monitoring disease activity in atopic dermatitis. Br J Dermatol 1996; 135(48 Suppl.): 25–30

    Article  PubMed  Google Scholar 

  4. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985; 107: 669–75

    Article  PubMed  CAS  Google Scholar 

  5. Sampson HA, Broadbent KR, Bernhisel-Broadbent J. Spontaneous release of histamine from basophils and histamine-releasing factor in patients with atopic dermatitis and food hypersensitivity. N Engl J Med 1989; 321: 228–32

    Article  PubMed  CAS  Google Scholar 

  6. Webber SA, Graham-Brown RA, Hutchinson PE, et al. Dietary manipulation in childhood atopic dermatitis. Br J Dermatol 1989; 121: 91–8

    Article  PubMed  CAS  Google Scholar 

  7. Kajosaari M, Saarinen UM. Prophylaxis of atopic disease by six months’ total solid food elimination: evaluation of 135 exclusively breast-fed infants of atopic families. Acta Paediatr Scand 1983; 72: 411–4

    Article  PubMed  CAS  Google Scholar 

  8. Gustafsson D, Lowhagen T, Andersson K. Risk of developing atopic disease after early feeding with cows’ milk based formula. Arch Dis Child 1992; 67: 1008–10

    Article  PubMed  CAS  Google Scholar 

  9. Kramer MS. Maternal antigen avoidance during lactation for preventing atopic disease in infants of women at high risk (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 3. Oxford: Oxford Update Software, 2000: CD000131

    Google Scholar 

  10. Gdalevich M, Mimouni D, David M, et al. Breast-feeding and the onset of atopic dermatitis in childhood: a systematic review and meta-analysis of prospective studies. J Am Acad Dermatol 2001; 45: 520–7

    Article  PubMed  CAS  Google Scholar 

  11. Kramer MS. Maternal antigen avoidance during pregnancy for preventing atopic disease in infants of women at high risk (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 3. Oxford: Oxford Update Software, 2000: CD000133

    Google Scholar 

  12. Glover MT, Atherton DJ. A double-blind controlled trial of hyposensitization to dermatophagoides pteronyssinus in children with atopic eczema. Clin Exp Allergy 1992; 22(4): 440–6

    Article  PubMed  CAS  Google Scholar 

  13. Beck H-I, Bjerring P, Harving H. Atopic dermatitis and the indoor climate. Acta Derm Venereol 1989; 69: 162–5

    PubMed  CAS  Google Scholar 

  14. Sanda T, Yasue T, Oohashi M, et al. Effectiveness of house dust mite allergen avoidance through clean room therapy in patients with atopic dermatitis. J Allergy Clin Immunol 1992; 89: 653–7

    Article  PubMed  CAS  Google Scholar 

  15. Ricci G, Patrizi A, Specchia F, et al. Effect of house dust mite avoidance measures in children with atopic dermatitis. Br J Dermatol 2001; 144(4): 912–3

    Article  Google Scholar 

  16. Friedmann PS, Tan BB. Mite elimination: clinical effect on eczema. Allergy 1998; 53(48 Suppl.): 97–100

    Article  PubMed  CAS  Google Scholar 

  17. Tan BB, Weald D, Strickland I, et al. Double-blind controlled trial of effect of house dust-mite allergen avoidance on atopic dermatitis. Lancet 1996; 347(8993): 15–8

    Article  PubMed  CAS  Google Scholar 

  18. Wolkerstorfer A, Strobos MA, Glazenburg EJ, et al. Fluticasone propionate 0.05% cream once daily versus clobetasone butyrate 0.05% cream twice daily in children with atopic dermatitis. J Am Acad Dermatol 1998; 39 (2 Pt 1): 226–31

    Article  PubMed  CAS  Google Scholar 

  19. Jorizzo J, Levy M, Lucky A, et al. Multicenter trial for long-term safety and efficacy comparison of 0.05% desonide and 1% hydrocortisone ointments in the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol 1995; 33(1): 74–7

    Article  PubMed  CAS  Google Scholar 

  20. Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000; 4(37): 1–191

    PubMed  CAS  Google Scholar 

  21. Turpeinen M. Percutaneous absorption of hydrocortisone and adrenocortical suppression in patients with dermatitis [dissertation]. Helsinki: Helsinki University, 1988

    Google Scholar 

  22. Oikarinen A, Haapasaari KM, Sutinen M, et al. The molecular basis of glucocorticoid-induced skin atrophy: topical glucocorticoid apparently decreases both collagen synthesis and the corresponding collagen mRNA level in human skin in vivo. Br J Dermatol 1998; 139(6): 1106–10

    Article  PubMed  CAS  Google Scholar 

  23. Schnopp C, Holtmann C, Stock S, et al. Topical steroids under wet-wrap dressings in atopic dermatitis: a vehicle-controlled trial. Dermatology 2002; 204(1): 56–9

    Article  PubMed  CAS  Google Scholar 

  24. Stern RS, Lunder EJ. Risk of squamous cell carcinoma and methoxsalen (psoralen) and UV-A radiation (PUVA): a meta-analysis. Arch Dermatol 1998; 134(12): 1582–5

    Article  PubMed  CAS  Google Scholar 

  25. Jekler J, Larkö O. UVB phototherapy of atopic dermatitis. Br J Dermatol 1988; 119: 697–705

    Article  PubMed  CAS  Google Scholar 

  26. Jekler J, Bergbrant I-M, Faergemann J, et al. The in vivo effect of UVB radiation on skin bacteria in patients with atopic dermatitis. Acta Derm Venereol 1992; 72: 33–6

    PubMed  CAS  Google Scholar 

  27. George SA, Bilsland DJ, Johnson BE, et al. Narrow-band (TL-01) UVB air-conditioned phototherapy for chronic severe adult atopic dermatitis. Br J Dermatol 1993; 128(1): 49–56

    Article  PubMed  CAS  Google Scholar 

  28. Krutmann J, Diepgen TL, Luger TA, et al. High-dose UVA1 therapy for atopic dermatitis: results of a multicenter trial. J Am Acad Dermatol 1998; 38(4): 589–93

    Article  PubMed  CAS  Google Scholar 

  29. Berth-Jones J, Finlay AY, Zaki I, et al. Cyclosporine in severe childhood atopic dermatitis: a multicenter study. J Am Acad Dermatol 1996; 34(6): 1016–21

    Article  PubMed  CAS  Google Scholar 

  30. Camp RDR, Reitamo S, Friedmann PS, et al. Cyclosporin A in severe, therapy-resistant atopic dermatitis: report of an international workshop, April 1993. Br J Dermatol 1993; 129: 217–20

    Article  PubMed  CAS  Google Scholar 

  31. Granlund H, Erkko P, Reitamo S. Long-term follow-up of eczema patients treated with cyclosporine. Acta Derm Venereol 1998; 78: 40–3

    Article  PubMed  CAS  Google Scholar 

  32. Eichenfield LF, Lucky AW, Boguniewicz M, et al. Safety and efficacy of pimecrolimus (ASM 981) cream 1% in the treatment of mild and moderate atopic dermatitis in children and adolescents. J Am Acad Dermatol 2002; 46: 495–504

    Article  PubMed  Google Scholar 

  33. Kapp A, Papp K, Bingham A, et al. Long-term management of atopic dermatitis in infants with topical pimecrolimus, a nonsteroid anti-inflammatory drug. J Allergy Clin Immunol 2002; 110: 277–84

    Article  PubMed  CAS  Google Scholar 

  34. Palier A, Eichenfield LF, Leung DY, et al. A 12-week study of tacrolimus ointment for the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol 2001; 44(1 Suppl.): S47–57

    Article  Google Scholar 

  35. Boguniewicz OM, Fiedler VC, Raimer S, et al. A randomized, vehicle-controlled trial of tacrolimus ointment for the treatment of atopic dermatitis in children. J Allergy Clin Immunol 1998; 102 (4 Pt 1): 555–7

    Article  Google Scholar 

  36. Reitamo S, Rissanen J, Remitz A, et al. Tacrolimus ointment does not affect collagen synthesis: results of a single-center randomized trial. J Invest Dermatol 1998; 111: 396–8

    Article  PubMed  CAS  Google Scholar 

  37. Allen A, Siegfried E, Silverman R, et al. Significant absorption of topical tacrolimus in 3 patients with Netherton syndrome. Arch Dermatol 2001; 137: 747–50

    PubMed  CAS  Google Scholar 

  38. Hanifin JM, Schneider LC, Leung DYM, et al. Recombinant interferon gamma therapy for atopic dermatitis. J Am Acad Dermatol 1993; 28: 189–97

    Article  PubMed  CAS  Google Scholar 

  39. Giustina TA, Chan SC, Thiel ML, et al. Increased leukocyte sensitivity to phosphodiesterase inhibitors in atopic dermatitis: tachyphylaxis after theophylline therapy. J Allergy Clin Immunol 1984; 74: 252–7

    Article  PubMed  CAS  Google Scholar 

  40. Hanifin JM, Chan S. Biochemical and immunologic mechanisms in atopic dermatitis: new targets for emerging therapies. J Am Acad Dermatol 1999; 41: 72–7

    Article  PubMed  CAS  Google Scholar 

  41. Stiller MJ, Shupack JL, Kenny C, et al. A double-blind, placebo-controlled clinical trial to evaluate the safety and efficacy of thymopentin as an adjunctive treatment in atopic dermatitis. J Am Acad Dermatol 1994; 30: 597–602

    Article  PubMed  CAS  Google Scholar 

  42. Hsieh KH, Shaio MF, Liao TN. Thymopentin treatment in severe atopic dermatitis: clinical and immunological evaluations. Arch Dis Child 1992; 67(9): 1095–102

    Article  PubMed  CAS  Google Scholar 

  43. Bjorneboe A, Soyland E, Bjorneboe GE, et al. Effect of n-3 fatty acid supplement to patients with atopic dermatitis. J Intern Med Suppl 1989; 225: 233–6

    Google Scholar 

  44. Soyland E, Funk J, Rajka G, et al. Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis: a double-blind, multicentre study. Br J Dermatol 1994; 130: 757–64

    Article  PubMed  CAS  Google Scholar 

  45. Kiistala R. Sweat secretion in normal and atopic skin [dissertation]. Helsinki: Helsinki University, 1992

    Google Scholar 

  46. Werner Y, Lindberg M. Transepidermal water loss in dry and clinically normal skin in patients with atopic dermatitis. Acta Derm Venereol 1985; 65: 102–5

    PubMed  CAS  Google Scholar 

  47. Imokawa G, Hattori M. A possible function of structural lipids in the water-holding properties of the stratum corneum. J Invest Dermatol 1985; 84: 282–4

    Article  PubMed  CAS  Google Scholar 

  48. Hannuksela A, Kinnunen T. Moisturizers prevent irritant dermatitis. Acta Derm Venereol 1992; 72: 42–4

    PubMed  CAS  Google Scholar 

  49. Schafer L, Kragballe K. Supplementation with evening primrose oil in atopic dermatitis: effect on fatty acids in neutrophils and epidermis. Lipids 1991; 26: 557–60

    Article  PubMed  CAS  Google Scholar 

  50. Morse PF, Horrobin DF, Manku MS, et al. Meta-analysis of placebo-controlled studies of the efficacy of Epogam in the treatment of atopic eczema: relationship between plasma essential fatty acid changes and clinical response. Br J Dermatol 1989; 121: 75–90

    Article  PubMed  CAS  Google Scholar 

  51. Berth-Jones J, Graham-Brown RA. Failure of terfenadine in relieving the pruritus of atopic dermatitis. Br J Dermatol 1989; 121: 635–7

    Article  PubMed  CAS  Google Scholar 

  52. Wilkinson RD, Collins JP, Raymond GP, et al. Therapy of infected dermatitis: comparative response to two corticosteroid antimicrobial creams. J Am Acad Dermatol 1980; 2: 207–11

    Article  PubMed  CAS  Google Scholar 

  53. Reimitz A, Kyllönen H, Granlund H, et al. Reduction of staphylococcal colonisation of skin in atopic dermatitis with 0.1% tacrolimus ointment therapy. J Allergy Clin Immunol 2001; 107: 196–7

    Article  Google Scholar 

  54. Devos SA, van der Valk PG. The relevance of skin prick tests for Pityrosporum ovale in patients with head and neck dermatitis. Allergy 2000; 55(11): 1056–8

    Article  PubMed  CAS  Google Scholar 

  55. Lindgren L, Wahlgren CF, Johansson SG, et al. Occurrence and clinical features of sensitization to Pityrosporum orbiculare and other allergens in children with atopic dermatitis. Acta Derm Venereol 1995; 75(4): 300–4

    PubMed  CAS  Google Scholar 

  56. Faergemann J. Pityrosporum infections. J Am Acad Dermatol 1984; 31 Suppl.: S18–20

    Article  Google Scholar 

  57. Lintu P, Savolainen J, Kortekangas-Savolainen O, et al. Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts. Allergy 2001; 56(6): 512–7

    Article  PubMed  CAS  Google Scholar 

  58. Broberg A, Faergemann J. Topical antimycotic treatment of atopic dermatitis in the head/neck area. Acta Derm Venereol 1992; 72: 187–92

    PubMed  CAS  Google Scholar 

  59. Wahlgren CF, Hagermark O, Bergstrom R. The antipruritic effect of a sedative and a non-sedative antihistamine in atopic dermatitis. Br J Dermatol 1990; 122: 545–51

    Article  PubMed  CAS  Google Scholar 

  60. Wahlgren CF, Scheynius A, Hagermark O. Antipruritic effect of oral cyclosporin A in atopic dermatitis. Acta Derm Venereol 1990; 70: 323–9

    PubMed  CAS  Google Scholar 

  61. Moore C, Ehlayel MS, Junprasert J, et al. Topical sodium cromoglycate in the treatment of moderate-to-severe atopicdermatitis. Ann Allergy Asthma Immunol 1998; 81 (5 Pt 1): 452–8

    Article  PubMed  CAS  Google Scholar 

  62. Businco L, Cantani A. Oral sodium cromoglycate in the management of atopic dermatitis in children. Allergy Proc 1991; 12: 333–8

    Article  PubMed  CAS  Google Scholar 

  63. Businco L, Meglio P, Amato G, et al. Evaluation of the efficacy of oral cromolyn sodium or an oligoantigenic diet in children with atopic dermatitis: a multicenter study of 1085 patients. J Investig Allergol Clin Immunol 1996; 6(2): 103–9

    PubMed  CAS  Google Scholar 

  64. Ewing CI, Gibbs AC, Ashcroft C, et al. Failure of oral zinc supplementation in atopic eczema. Eur J Clin Nutr 1991; 45: 507–10

    PubMed  CAS  Google Scholar 

  65. Sheehan MP, Atherton DJ. One-year follow up of children treated with Chinese medicinal herbs for atopic eczema. Br J Dermatol 1994; 130: 488–93

    Article  PubMed  CAS  Google Scholar 

  66. Fung AY, Look PC, Chong LY, et al. A controlled trial of traditional Chinese herbal medicine in Chinese patients with recalcitrant atopic dermatitis. Int J Dermatol 1999; 38(5): 387–92

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The author has participated as investigator in studies on tacrolimus sponsored by Fujisawa GmbH, Germany. Since January 2002 the author has held a position as Medical Advisor at Novartis, Finland.

Author information

Authors and Affiliations

  1. Department of Dermatology, Helsinki University Central Hospital, Helsinki, Finland

    Håkan Granlund

Authors
  1. Håkan Granlund
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Håkan Granlund.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Granlund, H. Treatment of Childhood Eczema. Pediatr-Drugs 4, 729–735 (2002). https://doi.org/10.2165/00128072-200204110-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00128072-200204110-00004

Keywords

Search

Navigation