Pharmacist’s Antidote | As autumn approaches, how should babies with eczema use hormones correctly?

Eczema is an allergic inflammatory skin disease caused by a variety of internal and external factors. It is one of the most common skin diseases in infancy. It often occurs on the cheeks, forehead and scalp of the face, but also on the buttocks and flexor sides of the limbs. It is itchy and prone to recurrence, which brings great pain to babies and parents.

When it comes to the treatment of eczema, one topic that cannot be avoided is how to use glucocorticoids (hereinafter referred to as hormones) in a standardized manner. In clinical work, many parents of children with the disease are overly afraid of the side effects of hormone drugs, and there is a situation of "hormone fear". Failure to use them in a standardized manner leads to repeated illness and prolonged illness. In fact, if used properly, hormones are still a safe and effective first-line choice for the treatment of moderate to severe eczema. In the face of eczema, how should babies use hormones correctly?

Understand the strength level and choose the right hormone

In clinical practice, the intensity of topical glucocorticoids is often divided into four levels based on methods such as skin vasoconstriction tests. That is, super potent, strong, medium and weak. The structure of the hormone is the main factor that determines its intensity, but its concentration and dosage form also have a great impact on it.

When choosing hormones for the treatment of eczema, factors such as the patient's age, the affected area of ​​the body, and the degree of skin inflammation should be considered, and low-grade topical hormones should be given priority. For eczema on the face, neck, and skin folds, it is recommended to choose weak topical hormones as much as possible, or at least choose this grade of topical hormones for initial treatment. If necessary, topical calcineurin inhibitors can be used instead. When used topically for a short period of time, there is no need to worry about the side effects of topical hormones. If the eczema is very severe, a doctor should be asked to evaluate and then choose a suitable topical hormone ointment.

Commonly used topical glucocorticoid preparations (from high to low strength)

Data citation: "Expert consensus on standardizing topical glucocorticoids", Chinese Journal of Dermatology, Vol. 48, No. 2, February 2015

Regulating the use of topical hormones

1. Usage and Dosage

Number of times of use: 1 to 2 times a day, not too many times; add sufficient moisturizer 15 to 30 minutes after taking the medicine; the area of ​​the ointment used on the whole body should not exceed 1/3 of the body surface area as much as possible.

Dosage selection: The fingertip unit is the most practical for the dosage of ointment. Specifically: the dose of medicine squeezed from the standard packaging tube to the tip of the index finger weighs about 0.5 grams, which is enough to apply to the skin within the range of two palms.

Medication course:

(1) Hormone ointment of the same concentration should not be used continuously for more than 2 weeks on the same part;

(2) It is best not to use hormone ointment on the face for more than 2 weeks;

(3) Continuous use of hormone ointment on areas with weak skin, such as the armpits and vulva, should not exceed 1 week.

(4) Generally, symptoms will disappear after using topical hormone ointments for about 7 days in a row, but you should not stop when you see improvement. You can continue to use it every other day for a week, and finally use it every two days for a week before stopping.

(5) For severe cases, the medication can be continued for 2 days a week for 1-2 months to prevent recurrence. If the medication is used too little or stopped too quickly, the child's eczema may continue to recur and be difficult to cure.

2. Precautions

Standardized use of glucocorticoids is relatively safe. Although long-term and excessive use of topical hormones may cause problems such as thinning of the skin, dilation of capillaries, pigmentation, and skin atrophy, high-intensity hormones are generally not used for children, and are only used topically. The amount absorbed by the skin is very small and will not affect their normal growth and development. However, it should still be emphasized that the use of topical hormones must be strictly followed according to the doctor's instructions and standardized.

In the relatively dry autumn and winter seasons, in order to avoid recurring eczema, children should be given baby moisturizer more often. The principle is "multiple and sufficient application", and sufficient application is considered sufficient until the skin is smooth and moisturized. If the skin is dry and flaky, the application frequency needs to be increased. If necessary, it can be used topically 5 to 10 times a day.