Eczema (atopic dermatitis) is the most common skin condition in children, affecting around 1 in 5 in the UK. Managing it well makes a significant difference to quality of life — for the child who is uncomfortable and itchy, and for the family. There are effective treatments at every level of severity.
For a comprehensive overview, see our complete guide to child health.
The Foundation: Emollients
Emollients are moisturisers that repair and maintain the skin barrier that is defective in eczema. They are the cornerstone of treatment and should be applied:
- Multiple times daily — at least twice, and more often in dry conditions or after bathing
- To all affected skin, not just visibly dry patches
- Immediately after bathing (within minutes) to trap moisture in the skin
- As a soap substitute — emollients can be used in the bath instead of soap, which strips the skin barrier
The choice of emollient is largely down to what the child tolerates — thicker preparations (ointments) are more effective but less pleasant to apply; lighter creams are easier to use but need more frequent application. Emollient sprays and bath additives are available. Fragranced products should be avoided.
Topical Corticosteroids for Flares
When eczema flares — red, inflamed, itchy patches — topical corticosteroids (steroid creams and ointments) reduce inflammation rapidly. They are prescribed by potency:
Mild potency (e.g., hydrocortisone 1%): First-line for mild flares, recommended for the face and skin folds, and generally safe for continued use. Available over the counter in some strengths.
Moderate potency (e.g., clobetasone butyrate 0.05%): For moderate flares on the body. Usually prescribed.
Potent (e.g., betamethasone valerate 0.1%): For severe flares or resistant patches on the body. Not recommended for face or skin folds without specialist advice.
How to use: Apply to red, inflamed areas only — not to normal skin. Use for the shortest effective course (typically 5–7 days for a flare), then stop and revert to emollient alone. The fingertip unit is a guide to quantity.
Steroid phobia: Many parents are reluctant to use topical steroids due to fear of side effects. When used correctly (appropriate potency for the site, short courses for flares, not under occlusion), topical steroids on children's skin are safe and do not cause systemic effects. Undertreating eczema with an inadequate amount of steroid is more common than overuse, and leads to prolonged suffering and repeated courses.
Steroid-Sparing Agents (Topical Calcineurin Inhibitors)
Tacrolimus ointment (Protopic) and pimecrolimus cream (Elidel) are topical immunosuppressants prescribed for moderate-to-severe eczema, particularly on the face and eyelids where repeated steroid use is more concerning. They are second-line treatments, typically initiated by a specialist or after a GP has seen the child.
Antihistamines
Sedating antihistamines (such as chlorphenamine — Piriton) are sometimes used at night for eczema, primarily to reduce itching enough to allow sleep. Their benefit in eczema is modest — they don't treat the underlying inflammation. Non-sedating antihistamines have no evidence of benefit in eczema.
Wet Wrapping
Wet wrapping involves applying emollient or dilute topical steroid under wet bandages, then dry bandages or garments on top. It intensifies treatment for severe flares and can provide significant relief in a short period. It is usually taught by a specialist nurse.
Trigger Management
Identifying and reducing triggers can reduce flare frequency:
- Heat and sweating — often a significant trigger; lightweight, natural-fibre clothing, cool room temperature
- Scratching — itching is partly reflex; keeping nails short, mittens at night in babies
- Certain fabrics — wool and synthetic fibres often irritate; cotton and bamboo tend to be better tolerated
- House dust mites — in children with dust mite allergy, reduction measures can reduce eczema severity
- Some foods — food allergy can exacerbate eczema in a subset of children; unnecessary elimination diets without clear trigger identification should be avoided
When to Refer to a Specialist
Referral to a paediatric dermatologist or allergy specialist is appropriate when:
- Eczema is severe and not responding to first-line treatment
- Food allergy is suspected as a contributor
- The diagnosis is unclear
- Psychological impact on the child or family is significant
- Specialist procedures (wet wrapping, dupilumab) are being considered
Key Takeaways
Eczema management involves daily emollients applied multiple times to all affected skin, topical corticosteroids (mild for face/folds, moderate-potent for body flares) used for short courses, and trigger avoidance. Steroid phobia is common but incorrectly used topical steroids are safe when applied to appropriate sites for short courses. Steroid-sparing agents (tacrolimus, pimecrolimus) are second-line for moderate-severe cases. Identify triggers such as heat, sweating, certain fabrics, and dust mites; specialist referral is indicated for severe treatment-resistant eczema or suspected food allergy.
