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Baby Eczema and Steroid Use: What Parents Need To Know

When should you use steroids to help your baby's eczema? What different types of steroids are there, and what are best practices for applying them? Here's what parents need to know. 

When should I use steroids to help my baby’s eczema?

Eczema, or atopic dermatitis, affects up to 20% of babies and children.  Parents can help make their children feel more comfortable by practicing lifestyle habits and knowing what triggers may make the eczema worse.  Also, there are natural remedies and products to help your child’s eczema.  In fact, frequent use of moisturisers reduces the need for steroid creams.  Sometimes, however, eczema becomes so inflamed, red, and itchy that the only way to help the skin heal is through topical steroids.  While steroid creams are safe and essential for eczema care, it is important to note that topical steroids are prescribed by a medical doctor.  

Important to note: Only use steroids as prescribed by your doctor. Before using steroids, always discuss with your doctor to come up with a treatment plan.  

What are the different types of steroids?

-Mild: hydrocortisone cream 1%:  This is often used to treat children. If this does not work after 3-7 days, patients may be prescribed a stronger steroid.

-Moderate strength prescription topical steroid, such as triamcinolone acetonide 0.1% cream: Use this as soon as your child has a flare, with red, rough, itchy skin.

-High strength prescription topical steroid such as desonide 0.05% ointment

Note: Patients can be prescribed 2 or more of different strength steroids at the same time (for different needs of the body). 

-Oils or other medicated shampoos such as T/Sal can be used to help scalp needs (for example, 0.1% Elocon solution or DesOwens lotion after each shampoo).

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How long should I use the topical steroid?  

Topical steroids are used to clear flare-ups and timing and length of treatment can vary.  Once the flare-up has completely gone, you can stop the treatment, but continue using moisturizer every day.  Some doctors recommend using steroids for up to a week, and once the steroid use has stopped, continue to use an emollient two times a day to maintain the healed skin.  Patients can then use steroids again when a flare-up reoccurs.  After the flare clears, some doctors recommend using the steroid creams on areas that usually flare, three times per week to help prevent new flares.

It’s important that parents don’t undertreat the children's eczema for fear of topical steroids. This will ultimately require greater long term use of steroids to treat the eczema. If your child still has red, itchy, active eczema after 1-2 weeks, make an appointment with your doctor. Talk to your doctor about a skincare regimen that works for your child, especially if your child needs steroid creams most days of most weeks. 

What are the side effects of topical steroids? 

Steroids can cause thinning of the skin and cause the skin color to change. They may also cause a stinging feeling upon application to the skin.  Some children may develop an allergy to the treatment, especially if preservatives are used.  Some topical steroids get through the skin and into the bloodstream, and for children who need long term treatment with potent steroids, this can potentially affect the growth of the child.  It is important to make sure the child’s growth is monitored.  Moreover, topical steroids can also possibly produce adrenal insufficiency. Again, steroid use needs to be used under medical supervision.

What are the best practices of applying steroids?

  1. Wash hands before putting steroid (or any moisturizer) on child’s skin
  2. Apply steroid creams immediately after the bath. Apply a thin layer using the FTU method (see below)
  3. Use 1 or 2x a day (or as advised by doctor)
  4. Have parents wash their own hands after application of steroid
  5. Coat steroid with an emollient 

How much steroid should I apply? 

The Fingertip Unit (FTU) measurement is the amount of topical steroid that is squeezed out from a standard tube along an adult’s index finger to the first crease (or line) in the finger before being applied to the child’s skin. (Note: this is assuming the steroid comes from a standard 5 mm nozzle.)  The following gives a general guide:

FTU= Fingertip Unit

Other Resources:

National Eczema Association Topical Steroid Fingertip Guide

Paediatric Society of New Zealand Management Plan for Child Eczema

 

 

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All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.

These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease. If your infant has severe eczema, check with your infant’s healthcare provider before feeding foods containing ground peanuts.

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