Infantile eczema is a common chronic skin disease in children, and its treatment has become a clinical challenge because of its long duration and recurrent nature. Many parents have come to consult on the treatment of eczema. Our view is that “three parts depend on treatment, seven parts depend on care”, which means that we advocate the principle of treatment to restore the normal barrier function of the skin, find and remove triggering and/or aggravating factors, and reduce or relieve symptoms as the main goal.
Next, I will give you more details.
Parents should first fully understand that the disease is caused by a combination of internal and external factors, has a long course, is prone to recurrent attacks, and it is impossible to pursue a one-time cure. In daily life, the following points need to be noted to avoid all triggering or aggravating factors.
1. Feeding.
First of all, promote breastfeeding. The actual fact is that you can find a lot of people who are not able to get a good deal on this. For children with atopic dermatitis to add complementary foods, the following recommendations are provided.
① Amount of complementary foods added: start with a smaller amount than infants of the same age and add slowly in a progressive manner.
②Type of complementary foods: increase one by one, in a gradual manner.
③Adding the total amount of complementary foods: small amount and many meals.
(iv) Processing method of complementary foods: adequate steaming.
⑤ Feeding tools: spoons should be of appropriate size to avoid spillage of food to irritate the skin around the mouth. It is recommended to avoid foods with clear allergies.
2. Dressing.
The child’s clothing should be cotton, loose and soft, and slightly thinner than infants of the same age (it is crucial for the child to stay cool!). .
3, room environment.
Requires cool, ventilated and clean, it is recommended to use wet mop and rag to clean the living room to avoid the inhalation of house dust, mites and animal hair and other allergens.
4, skin cleaning care.
Bathing with soap, shampoo, water temperature is too hot and too long on the skin are stimulating factors, it is recommended that the bath time to 5-10 minutes, water temperature 36-38 ℃, the use of pH 5.5-6.0 mild body wash is better (such as Avène soap, etc.), immediately after the bath should use emollients.
5, the use of emollients.
Due to defective ceramide and intermediate filament-related protein in the epidermis of children with eczema leads to defective skin barrier function, which increases transepidermal water loss and dry skin, manifesting as skin itching and inflammation. Regular topical emollients not only significantly improve the above symptoms, but also maintain the hydration of the skin, which is an important basis for the general treatment of children with eczema. The best emollient should be selected according to the child’s skin condition, season, climate and other conditions, and applied systemically once or twice a day to achieve the best results.
What kind of emollient should be chosen? Some scholars suggest that emollients containing petroleum jelly, amino acids and urea, which are commonly used at present, only temporarily relieve dry skin, but to a certain extent reduce the skin barrier function and delay the repair of the barrier function, while emollients containing lipids and intermediate filament-related proteins can promote the repair of the skin barrier function while moisturizing, and their efficacy is equivalent to that of medium-acting glucocorticoid steroids. It has a broad application prospect. The marketed ones such as Avène Triple Nourishing Cream, Stavros Lotion, etc.
6. Glucocorticosteroids can be used when necessary.
Topical topical glucocorticosteroids and with the use of emollients is the main method of treatment of atopic dermatitis. Different types and strengths of preparations should be used according to the age, skin area and severity of the condition of the child. Weak to moderately potent glucocorticosteroid preparations are commonly used in children. In treating the disease, preparations of sufficient strength should be preferred, and the concentration of topical hormones should be gradually reduced or the strength of hormones should be lowered during the course of treatment according to the recovery of the skin lesions. Simply put, the disease should be killed with a single stroke and not allowed to resurface! After the skin inflammation is completely controlled, the skin looks normal, but the skin is actually in a subclinical inflammatory state internally, so it is recommended to continue the “active treatment” method of applying topical hormone preparations twice a week to control the inflammatory reaction and applying emollients at the same time, so as to keep it in a long-term remission state.
Note: Weak glucocorticoid hormone preparations (e.g., Eudragol ointment, Denide ointment, Elocon ointment, etc.) should be used on thin skin areas such as the face, neck, axillae, and groin. Strong hormones are rarely used in children, only in very severe localized lesions of mossy skin, and only for a short period of time. Once the lesions have resolved, the hormone is switched to a lower level of intensity. This is to avoid the side effects of topical hormones as much as possible.
Although side effects of long-term glucocorticosteroid use include skin atrophy, persistent facial erythema, capillary dilation, hirsutism, increased wrinkles, and glucocorticoid acne, topical weak to moderately potent hormones are rarely seen, especially in pediatric patients under 10 years of age. Long-term large-scale application can sometimes lead to systemic adverse reactions, which are rare in children.
7. Other topical treatments.
Calcium-regulated neurophosphatase inhibitors (such drugs mainly include tacrolimus ointment and pimecrolimus cream. For non-hormonal drugs, has a good anti-inflammatory effect, does not cause skin atrophy and other side effects of hormone therapy, can be applied to the face and neck and skin folds for a long time. Although it is a good medicine, it is generally suitable for children over 2 years old (not recommended for children under 2 years old). So for the clinical treatment of eczema topical topical drugs in the second line of drugs.) The topical anti-infective agents (eczema children’s skin can easily Staphylococcus aureus colonize the skin surface, and its secreted toxins then act as super-antigens to further aggravate the inflammatory response of the skin, so topical topical antibiotics can significantly reduce the number of skin Staphylococcus aureus and improve skin symptoms, short-term use is recommended for a 2-week course of treatment. (Commercially available antibiotics such as Bactroban, fusidic acid, compound polymyxin B, etc.)
8.Physical therapy.
Phototherapy can suppress the inflammatory response by inhibiting lymphocytes and regulating the production of cytokines, thus reducing the patient’s inflammation and pruritus symptoms. uva and uvb have therapeutic effects on lesions, but narrow-spectrum medium-wave uva and uva1 are more effective, and uva combined with topical glucocorticoid steroids is more effective. Although safe, there is no evidence of inquisitorial medicine for children under 12 years of age, use as appropriate.
After all, the most important thing is still 1-5, in the end: very good care can prevent the occurrence of eczema, and even 50% of children with very good care eczema can be self-healing, so “infant eczema, three points rely on treatment, seven points rely on care”, than treatment, eczema care moisturizing more important!