Eczema is a common itchy skin disease, which particularly affects young infants and children. Treatment includes

  • a moisturiser which act as a barrier and help to protect the skin from irritants and dirt
  • an anti-inflammatory cream or ointment, usually steroid
  • anti-histamines don’t reduce the itch of eczema and are of little use in this condition

Moisturisers:

Ointments stay on the surface of the skin. Creams seep into the skin and contain more chemicals that can irritate the skin.
For these reasons, ointments are preferred to creams.

Moisturisers to consider

Hydromol

Epaderm

Doublebase

Diprobase

Aveeno

Dermol cream (if skin regularly infected)

Choice of moisturiser depends on personal preference and cost.

Moisturisers to avoid

E45

Aqueous cream

Anti-inflammatory creams and ointments

Steroid creams and ointments have been used for many years to treat children's eczema. They come in different strengths: mild, moderate, potent, very potent.
Very potent steroids (Dermovate) should never be used to treat children's eczema
Most children with mild eczema respond to a mild steroid (1% hydrocortisone ointment) used twice a day. 1% hydrocortisone can be used regularly for many months or even years without a significant risk of skin thinning. More potent steroids should only be used for shorter periods of 1 week, unless directed by your doctor. 
Apply the anti-inflammatory cream or ointment FIRST, before applying the moisturiser.
Newer non-steroid anti-inflammatory creams and ointments are available. They are used in children who do not respond to 1% hydrocortisone ointment and have extensive eczema, particularly involving the face
If the anti-inflammatory creams and ointments don't work or stop working, the reason is not that the child has got used to the treatment. If the skin is crusty, oozing, painful and sticks to the clothes it is likely that it is infected. A course of antibiotics may be required to treat the infection. If the skin starts stinging and becoming more red when the creams are applied the child may have developed an allergy to them. Go and see your doctor. 

Fucidin based ointments should not be used for more than 1- 2 weeks, otherwise antibiotic resistance will develop.

Topical anti-inflammatory creams and ointments

Mild potency

steroid

Don’t bother with hydrocortisone 0.5% – too weak

1% hydrocortisone ointment twice a day is the preferred option for mild eczema

Moderate potency

steroid

Avoid on the face, neck, groin

 

Use for short 5 – 7 day bursts for moderate flares not caused by infection.

Potent

steroid

Avoid on the face, neck, groin

 

Use for short 5 – 7 day bursts for acute flares not caused by infection.

Very potent

steroid

Contraindicated in children.

Do not use.

Non

steroid

Don’t bother with Elidil – no better than 1% hydrocortisone

tacrolimus ointment is preferred option for children with extensive moderate eczema not responsive to 1% hydrocortisone

hydrocortisone 0.5%

hydrocortisone 1%

Betnovate-RD

Eumovate

Synalar 1 in 4

Betnovate

Elocon

Locoid

Synalar

Dermovate

pimecrolimus (Elidil) cream

tacrolimus ointment