This eczema factsheet was prepared by ICCPE Director, Orla Sheehan, and published in the Irish Pharmacy Journal in 1999. It documents the factors most pertinent in the treatment of childhood eczema and gives guidelines for the use of emollients and the application of topical steroids in infants and children.

1.1 Introduction
Eczema affects an estimated 5-15 percent of schoolchildren.
Eczema usually presents in infancy; 75 percent will develop eczema between the ages of 3-12 months.
Commonest sites in infancy are the face and extensor areas when the child begins to crawl. In childhood, antecubital and popliteal fossae and frictional areas e.g. wrists, ankles, neck
Cotton mittens are advisable in infants and children to prevent secondary infection from scratching and oral ingestion of topically applied treatments.

1.2 Emollients
Emollients are the cornerstone of treatment.
Mild eczema may be managed solely with emollients.
Emollients should be applied liberally several times a day and used as a soap substitute while bathing and hand-washing; children will require up to 250 g emollient per week
Ointments are better emollients than creams but most children and parents prefer creams
Choice of product should promoted adherence and disease management
Hydrated skin will allow better penetration of steroids where indicated
Preparations containing lactic acid and preservatives may cause hypersensitivity
Oils are often preferred for the bath; if eczema is severe enough should be supplied for two baths daily.
Identified triggers should be avoided

1.3 Topical corticosteroids
Topical corticosteroids are indicated for acute flare-ups and maintenance therapy, using the minimum effective potency.
Hydrocortisone (mild potency) is sufficient for most infants and children
More potent steroids in children are usually on the recommendation of a dermatologist
Where a more potent agent is needed, once eczema is controlled, treatment should revert to the least potent steroid.
Only hydrocortisone (0.5% and 1%) should be applied to the face and genital area
Over anxious parents can lead to sub-optimal management of eczema
Topical steroids should be applied twice daily and sparingly.
Parents and carers have caring interprestations of sparingly; the finer tip unit guide (FTU) is the gold standard (see table A below)
Secondary infection from scratching is a common cause of acute flare-ups and should be treated; fucidin H should be used for secondary bacterial infections
Secondary fungal infections may also occur
A sedative antihistamine is sometimes given to children at night to relieve intense itch and aid sleep

Table A: Finger tip unit (FTU) guide for application of topical steroids in infants and children*

*1 FTU = length of adult finger from finger tip to the first finger joint closest to the tip = 0.5g)

Example: An 18 month old child with eczema on the face, arms and hands will require a total of 4.5 FTUs applied twice daily, equivalent to 31.5 g weekly. Hence a 30 g tube for 1 week treatment.

Sheehan O. Management of Eczema Ir Pharm J 1999; 77:147-149 Long CC, Mills CM, Finlay AY et al. Br J Dermatol 1998;138:239-6