Dr. Alan Greene answers the question, Can I avoid using a steroid to treat my baby's eczema?
My daughter was diagnosed with eczema and was given a prescription for a cream. Should I use a cream or are there other ways to treat it?
Eczema is patches of sensitive skin that flares up in response to certain triggers. Thankfully, most kids do outgrow it. In the meantime, the best bet is to identify the triggers, if possible. Around age 1 it is often food -- milk, eggs, nuts, peanuts, wheat, fish, shellfish, citrus, or tomatoes. But it could also be heat, cold, wool, pet dander, or house dust.
Kids with eczema need a thin layer of a moisturizer applied every day, or even better, twice a day. There are many that work well, but for the face, I like Aquaphor. It is strong, yet gentle enough to use on the skin of premature infants. When there is a flare-up, kids often need something stronger to break the itch-scratch-itch cycle. Steroid creams are often used for that. These should not be used long-term and most doctors do not recommend using them on the face. The strongest steroid I feel comfortable with on the face is about 3 percent hydrocortisone -- about three times stronger than the hydrocortisone you could get over the counter.
If the 3 percent does not do the trick, I favor switching to a different type of medicine altogether, like Protopic cream. Most dermatologists agree with this approach. I've been hearing a number of pediatricians recently growing cavalier about the side effects of steroid cream on the face. They do work well, but to me the benefits do not outweigh the risks. The biggest side effects are scarring and thinning the skin, which is not very common, but enough so that it is not recommended.
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