3 Tried and True Methods of Pediatric Eczema Management

During the Society for Pediatric Dermatology (SPD) 2024 Pre-AAD Meeting in San Diego, CA, Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children’s Hospital – San Diego, delivered a lecture on the “tried and true” methods of pediatric atopic dermatitis management.

The session—a combination of “some data and things that I think,” Eichenfield quipped—provided a practical review of pediatric dermatology guidance and at-home care strategies that parents and guardians may present to their child’s caregiver.

Here are 3 facets of pediatric atopic dermatitis care and management that Eichenfield highlighted as a consistently reliable component:

Bathing and moisturizing

“Avoidance of bathing to avoid drying out skin is a practice that has no evidence basis,” Eichenfield said. “That used to be a standard recommendation.”

Eichenfield additionally noted that bleach baths “remain controversial” among dermatologists, though some studies have shown it may improve atopic dermatitis. There are data showing an enhanced skin barrier function, reduced itch and overall improved disease in such treated children—but a failure to normalize skin dysbiosis.

In instances when a child has colonized or infected eczema (described as “crusted” by appearance), Eichenfield emphasized that regular bathing may be highly beneficial.

Moisturizing separately reduces xerosis and the rate of progression toward anti-inflammatory medications in children with atopic dermatitis. Adversely, application of moisturizer may mobilize the absorption and activity of topical prescriptions as well. That said, evidence and experience are limited enough to Eichenfield that he does not particularly recommend one brand over another.

Topical Corticosteroids

Eichenfield highlighted the frequent rapid anti-inflammatory response observed with corticosteroids indicated for pediatric patients—adding that they remain a relatively low-cost treatment option in an increasingly competitive market.

A recurring issue in the prescription of corticosteroids, however, is the frequent trend of misinformed phobia coming from patients and their parents—a fear that Eichenfield said has actually evolved in rationale throughout his career.

“My (cases of) ‘steroid-phobia’ from the past were way easier than it is now,” Eichenfield said. “Social media has clearly influenced patients’ concerns about topical corticosteroids.”

After presenting a case of a young child with worsening eczema whose parents were resistant to initiating corticosteroid treatment due to the mother’s negative experience with such a prescription, Eichenfield stressed that literature is “replete” with similar cases: infants with severe atopic dermatitis with failure to thrive, electrolyte abnormalities, hypoalbuminemia, hypoproteinemia, and more.

“We do have to deal with different ways by which patients access their information,” he warned.

EASI, BSA, v-IGA

Eichenfield highlighted a recent specialist consensus for the utility of Eczema Area Severity Index (EASI) as the standard measure for clinical trial outcomes in atopic dermatitis, despite a wide swath of skin area-related metrics frequenting studies now.

He also gave a personal recommendation for the use of Body Surface Area (BSA) and Validated Investigator Global Assessment (v-IGA) scores in the assessment of pediatric patients with moderate to severe disease. Alternatively, clinicians may consider the Atopic Dermatitis Control Tool (ADCT) or the patient-reported Recap of Atopic Dermatitis (RECAP) questionnaire to gauge children and adolescent’s disease status and severity.