According to a recent survey among dermatologists, nearly three-quarters of parents with children who have atopic eczema worry about using topical steroids and almost a quarter are non-compliant.
BY Amy Anderson 5 July, 2007
Atopic dermatitis, or eczema, is a common problem in infants and children. It usually begins between two and six months of age with very dry and sensitive skin that will then become red and extremely itchy. It often starts on the forehead, cheeks and scalp and spreads to the trunk, creases of the elbows, knees, and wrists. With scratching the rash may become raw, crusted and weepy. Some children with these symptoms go on to develop problems such as depression with low self esteem, and have difficulty coping at school or work.
It is not yet known what causes atopic eczema, but it does seem to run in families that have a history of asthma, allergies or atopic dermatitis. It is a chronic disease, but only about a third of children with infantile atopic dermatitis will continue to have problems with it as they get older.
There is no cure for this common condition. The main treatments are aimed at controlling and preventing inflammation and itching and include avoiding triggers, frequent bathing and hydrating of the skin, liberal use of moisturizers and lubricants, and the use of steroid creams for flare ups.
There are two types of topical steroids that can be bought from pharmacy without prescription. Hydrocortisone is a mildly potent topical steroid and clobetasone butyrate, which is a moderately potent topical steroid. However, although topical steroids can be supplied in this way they should not be used in pregnancy or by someone under the age of 10.
Steroids are a serious drug and so need to be used with caution and then stopped as soon as symptom go. Stronger topical steroids should only be used for a few days on children which means often there is no relief for the in between days or any means of administering preventative measures. Steroids should never be used to prevent eczema occurring, only to treat the symptoms.
If ever used over a long period of time topical steroids can, especially in children, thin the skin making it appear transparent, fragile and over susceptible to bruising. Blood vessels may also become more prominent. With time the skin can become so badly damaged that it looses its elasticity so that stretch marks develop.
There is also a risk from topical steroids being absorbed into the blood through the skin. Again the likelihood of this occurring is linked to the amount of steroid used and the age of the person involved. The main problem relating to the absorption of steroids is a slowing down of growth in children by suppression of the adrenal gland. It is for this reason that strong steroids will only be prescribed for short periods of time for young children and if required over long periods of time only under the supervision of, and monitoring by, a hospital specialist.