Whether your child has mild redness or a scaly rash from head to toe, her doctor may prescribe different types of safe and effective drugs.
Topical corticosteroids. These over-the-counter and prescription medications reduce the inflammation associated with eczema. "Parents often panic because they associate the word steroids with performance-enhancing, muscle-building steroids, but those anabolic steroids are completely different from the creams we prescribe for eczema," says Helen T. Shin, MD, chief of pediatric and adolescent dermatology at Hackensack University Medical Center, in New Jersey. The creams mimic cortisol and hydrocortisone, two steroid hormones your body naturally produces to control inflammation. In fact, the biggest problem doctors often see with topical corticosteroids is that parents are reluctant to apply them to their child's skin when eczema flares up. "As a result, the eczema lingers and worsens so that a child eventually needs even more potent corticosteroids to get her symptoms under control," says Dr. Schaffer. With uninterrupted use over long periods of time, topical corticosteroids can cause side effects such as thinning of the skin and stretch marks. However, short-term daily use (for up to a month at a time) or long-term intermittent use (two days a week) hasn't been associated with these complications.
Immunomodulators. These newer topical anti-inflammatory medications, Elidel and Protopic, were approved more than five years ago for kids over age 2. Because they don't have the potential side effect of thinning of the skin that is associated with corticosteroids, they're particularly useful for fragile areas such as eyelids, armpits, and groin. However, many parents and doctors stopped giving children these topical medications when the FDA issued a black-box warning last year, citing evidence that the drugs increased the risk of lymphoma in animals. Both the American Academy of Dermatology and the American Academy of Allergy, Asthma and Immunology say the drugs haven't been shown to cause immune suppression or an increased cancer risk in humans. "The amount given to animals was up to 47 times higher than the maximum recommended dose for humans," says Dr. Paller. "But it seems like a lot of pediatricians have been scared away from using these valuable drugs."
Antihistamines. Over-the-counter drugs like Benadryl can help relieve itching because of their sedative effects, says Dr. Paller. "If you give your child an antihistamine before he goes to bed, he'll probably sleep better." However, if he's really itchy, he might still start scratching later during the night.