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Alternatives to Steroid Creams in Atopic Eczema

The Teams' view on steroid creams

As stated in our handout "Atopic eczema and steroid creams", corticosteroid ointments and creams that have been designed for use on the skin are perfectly safe for children with atopic eczema providing they are used correctly i.e. in short bursts and the right strength for the right part of the body. Back in the early 1970s, some people did suffer from side effects such as thinning of the skin when these were used incorrectly but these do not occur with the modern preparations if used as directed. Professor Williams still uses these preparations for his own atopic eczema and he also uses these preparations on his daughter. He has not seen a single side effect of topical corticosteroid preparations since he has been at QMC although he sees a lot of children suffering from severe eczema who have been denied the benefit of even the weakest preparations.

It is true however that none of these corticosteroid preparations cure atopic eczema - they can suppress the symptoms of inflammation such as soreness and itching for short periods. We do recognise that some parents may wish to chose an alternative approach to these preparations because of their short term effect and because some children with severe atopic eczema may not get enough relief from them.

Here are some possible options for you to think about

1 Regular moisturisers and protection from scratching only.
Find a good moisturiser (emollient) that your child likes and use it every day on your child's dry skin. Methods to reduce damage to the skin caused by scratching such as cotton gloves at night or covering the moisturisers with wet wrap or paste bandages are other ways of helping a child with mild eczema.

2 Tar creams and ointments.
Weak tar preparations have an anti-itching effect and have been used for at least 50 years in the treatment of eczema. They have a relatively weak action and they may irritate broken skin. They are nevertheless useful for very thickened eczema, especially when worn under a paste bandage. Tar preparations have a slight odour and they can stain clothing.

3 Dietary factors.
As our handout on "Diet and atopic eczema" tells you, we do not recommend a dietary approach unless you notice that your child's atopic eczema gets worse when a particular food is given. In those circumstances, you must avoid that food completely for at least 6 weeks and then have the courage to reintroduce the food to your child to see if it really does make a difference. Food allergies may be important in atopic eczema in the first 18 months of life and the commonest foods are usually i) dairy products, ii) citrus fruits iii) fish and shellfish, iv) nuts. Remember, if you do try a dietary approach, see a paediatric dietician to make sure that your child has adequate calories, vitamins and calcium.

4 Reducing house dust mite around the home.
Although it is impossible to completely eradicate house dust mites in your home, there are a number of simple measures which will reduce them and hopefully improve your child's eczema. It may also improve other family members who suffer from allergies related to house dust mite. Please see our house dust mite sheet for further information on how to do this.

5 Antihistamines.
Antihistamine tablets are generally not very helpful in atopic eczema because histamine does not play a very large part in causing the itch of atopic eczema. Sedative antihistamines used in short bursts at night for breaking up a broken sleep routine may be helpful however.

6 Antibiotics for skin infections.
We know that infection with a bacterium called Staph aureus is one of the commonest reasons why childhood atopic eczema may suddenly flare up and become very red and weepy. Using moisturisers regularly to grease the skin discourages these bacteria from inhabiting the skin and some bath additives may help too. However, if your child has infected atopic eczema, a 10 day course of antibiotics taken by mouth (Flucloxacillin provided your child is not sensitive to penicillin) is needed. Please see our "Atopic eczema and infections" Leaflet.

7 Methods to reduce your child's desire to scratch.
Some have used techniques such as teaching your child to pinch, rub or stroke the skin rather than scratch it which always causes more damage. Some have even used distraction and hypnosis as a means of helping children who have a very scratched skin to help them overcome these problems.

8 Evening primrose oil.
This has been available for atopic eczema for quite a while. Clinical trials of its use in childhood eczema are conflicting. If it has any effect on atopic eczema, the effects are quite small. However, if you do have a child with severe eczema who has failed to respond to a number of other measures, then this approach is worth trying. Children need between 1-2 capsules twice a day and the contents can be poured over food if your child does not like swallowing the capsules. If no response is noticed within 3 months, then it is probably not worth persisting with treatment.

9 Ultraviolet light.
You may have noticed that your child's eczema improves after a sunny holiday. This may be due to a number of effects such as having a change of environment and a rest but ultraviolet light itself has been shown to benefit children with atopic eczema. Because of the long term risk of skin cancer when too much ultraviolet light is given, this form of treatment is reserved for children with eczema unresponsive to other measures.

10 Traditional Chinese herbs.
Early clinical trials have shown that children with atopic eczema can often benefit from traditional Chinese herbs. Trials are still under way. There is some concern that some of the preparations can affect the liver and for this reason, they are usually only given to children with unresponsive eczema. You can obtain them either by going to a traditional Chinese practitioner (we would recommend blood tests before and during treatment) or it can be prescribed in the form of granules from the hospital in special cases.

11 Other powerful drugs which affect the immune system.
Two drugs, namely Azathioprine and Cyclosporin A are occasionally used to treat children with moderately severe to severe eczema who are unresponsive to other approaches. Both of these medicines have a range of side effects, some of which can be serious and it is for this reason that they are only prescribed in a hospital setting with facilities for adequate monitoring of problems before they occur.

12 Homeopathy/herbalism etc.
If all traditional medicine fails, then there is nothing stopping you from exploring other avenues to treat your child's atopic eczema. We cannot recommend anyone in particular because they have not been put to the test scientifically. More information about this is available in our information sheet on useful addresses but there are three recommendations that we would make.

1 Do not try everything at once
i.e. a mixture of creams, diet and herbalism, because if your child gets better, you will not know which one has done the trick. 2 Make sure that you visit a registered practitioner. 3 Please tell us if your child is undergoing any other form of treatment in case they interact with any of the prescribed medicines for your child.

© The Eczema Team Queen's Medical Centre, Nottingham, 1996