How Effective Are Corticosteroids for Eczema?

Infantile eczema (infantile eczema), which Chinese medicine calls "milk ringworm" or "fetal sores," is an allergic skin inflammation caused by a variety of internal and external factors. Skin lesions are polymorphic lesions that are dominated by papular herpes. They have a tendency to exudate, recurrent, and overlap between acute and chronic phases, accompanied by severe itching. The cause is often difficult to determine. The onset of this disease has no obvious seasonality, but it often recurs in winter, and it can be widespread or localized. Because the lesion is on the epidermis, there is generally no scar after healing.

Basic Information

nickname: Tinea pedis, fetal sores
English name: infantile eczema
Visiting department: Pediatrics

Multiple groups: Infants
Common locations: Head and face
Common causes: Related to genetics, environment, certain allergic substances, etc.
Common symptoms: Papules, small blister, erosion, exudate, strange itching

Causes of infant eczema

The etiology is complicated and related to a variety of internal and external factors, and sometimes it is difficult to determine the specific cause.

Internal factors

Such as the body's immune function imbalance or immune deficiency; endocrine diseases, nutritional disorders, chronic infections, tumors and other systemic diseases may also become the inherent cause of eczema; hereditary or acquired skin barrier dysfunction.

2. External factors

Ingestion of food-borne allergens in the digestive tract, such as allergens such as milk, fish, shrimp, beef and mutton, eggs, or the presence of allergens in the environment, can cause type allergies in the body. In addition, mechanical friction, such as saliva and galactorrhea, are often irritated, which is also the cause of the disease. Improper care, such as excessive use of strong alkaline soap, excessive nutrition, and abnormal digestion in the intestine can also cause the disease. Certain external factors, such as sunlight, ultraviolet rays, cold, damp heat, and other physical factors, contact with silk or artificial fibers, topical drugs, and skin bacterial infections can cause eczema or aggravate its condition.

Clinical manifestations of infant eczema

The onset is mostly 1 to 3 months after birth, and gradually decreases after 6 months. Most children heal after 1 and a half years. Some children are delayed until early childhood or childhood.

The severity of the disease is different. The rash is more common in the head and face, and gradually spreads to the neck, shoulders, trunk and limbs. The lesions are pleomorphic, with erythema or red papules at the beginning, which can gradually increase as the disease progresses. The disease appears as papules, small blisters, erosions, scabs, etc., sometimes good and bad, repeated attacks. There was a strange itch, the child cried at night, and was restless. Secondary infections can occur due to scratching, causing local lymphadenopathy, and very few children can develop systemic infections.

Clinical staging

(1) The onset is acute in the acute phase , and the skin shows most small clusters of small red papules and erythema. Basal edema quickly turns into papules and small blisters. The blisters erode and there is a clear yellow exudate or yellow-white slurry Sexual scabs, varying in thickness, with small papules scattered on the periphery. Facial skin may be flushed and swollen. Underarm, groin and other parts often combined with abrasions. Rupture may be secondary to infection. The child has obvious itching and irritability.

(2) Subacute phase Evolved from the acute phase of eczema due to improper treatment. Exudation of redness and swelling, crusts gradually reduced, the skin lesions are mainly small papules, there may be white scales, a little papules and erosive surfaces remain. Less itching

(3) Chronic phase It evolves from the acute and subacute phases, and it can also be the performance of the chronic phase from the beginning. Repeated attacks, more common in infants and children over 1 year old. The main clinical manifestations are rough skin, hypertrophy, pimples, scaly and pigmentation. Mostly distributed in the extremities, under certain incentives, it can be acute, and itching is obvious.

2. Clinical typing

(1) Seborrheic type is more common in infants of 1 to 3 months. The child's forehead, cheeks, and eyebrows are flushed, covered with yellow greasy scales, and a thick yellow liquid scab may be on top of the head. In severe cases, there may be abrasions, flushing, and exudation under the chin, neck, armpits, and groin.

(2) Exudative type It is more common in infants from 3 to 6 months, especially obese infants. The patient has bilateral red papules with symmetric millet grain size on both cheeks, small blisters and erythema between them, edema at the bottom, flaky erosion, and exudation of yellow slurry.

(3) Dry type is more common in infants from 6 months to 1 year old. Skin lesions are pimples, redness, hard bran-like scales, and scabs, which are common on the face, trunk, and lateral extremities.

Infant eczema diagnosis

According to the age of onset and the appearance of the rash, it usually starts after the full moon, and it usually occurs on the head and face, but the trunk can also be affected. The polymorphous rash in the acute phase is prone to exudate, severe itching, recurrent attacks and chronic infiltration , Hypertrophy and other characteristics, it is not difficult to diagnose. Laboratory tests are generally nonspecific, and eosinophils in the blood may increase.

Differential diagnosis of infant eczema

Rub the erythema

Rubbing erythema is more common behind the ears, groin, perianal area, and neck, and most often occurs in obese babies. It usually occurs in summer due to hot and humid, salivation, and improper local care.

2. Contact dermatitis

Contact dermatitis has a history of contact. Skin damage occurs at the contact site with clear boundaries. Feasible patch test identification.

3. Candida infection

Candida infections are pale red patches and flat papules with raised edges and clear borders. There may be a few scales on the edges, and thrush is often associated with it. Feasible fungal inspection.

4. Diaper Dermatitis

Eczema that occurs in the diaper area or around the anus should be distinguished from diaper dermatitis. Diaper dermatitis is a diffuse erythema, pimples, papules, and scales that are well-defined on the diaper area.

Baby eczema treatment

Diet management

It is best to find and avoid allergens. Such as milk protein allergy children should change to amino acid formula powder or deep hydrolyzed protein formula powder.

2. Protect skin barrier function

For exudative and dry eczema, if the surface is not ulcerated, the child should use some non-allergic moisturizing cream to play a moisturizing role. For severe eczema, topical corticosteroid cream can be applied topically for a short period of time, which has obvious anti-inflammatory and antipruritic effects. Pay attention to avoid prolonged application in large doses to avoid side effects. If the local ulcer is infected, topical application of antibiotic ointment is required for anti-inflammatory treatment.

3. Local treatment

It is the main method to treat infant eczema, and appropriate medication should be selected according to the eczema stage. In the acute stage, it is mainly swelling and pimples. If there is no exudation, calamine lotion, calamine furancillin lotion, glucocorticoid cream or gel are recommended; when there is a large amount of exudation, 1% to 3% should be selected. Boric acid solution, 0.1% furacicillin solution, cold and wet compress, zinc oxide oil can be used after wet compress, 1% chloramphenicol zinc oxide oil is applied topically when there is infection. In the subacute stage, it is recommended to wash with 1% to 3% boric acid solution or physiological saline, tincture of zinc oxide, and glucocorticoid cream. For chronic skin lesions, non-hormonal ointments (such as 20% -40% urea ointment, 5% -10% salicylic acid ointment, etc.) are recommended to be used in combination with glucocorticoid ointment.

4. Systemic treatment

(1) Oral antihistamines Oral antihistamines such as chlorpheniramine can be taken orally under the guidance of a doctor.

(2) Systemic application of corticosteroids, whether oral or intravenous corticosteroids, can quickly control symptoms, but it is easy to relapse after discontinuation, can not be cured, and has long-term application of dependence and various adverse reactions, so it should be appropriate Use with caution. For those with poor general eczema and other treatments, the prednisone can be taken orally for a short period of time, and gradually reduced after the condition improves.

(3) Antibiotics For children with extensive infection, fever, and increased white blood cell count, antibiotics can be applied systematically.

5. Chinese medicine treatment

External medicine is selected according to the eczema stage and wetness and dryness. The acute stage can be applied with a fine powder and Vaseline to make a paste for external application, or a large leaf boiled water filter residue for wet application. In the chronic period, Evodia rutaefolia can be used to add ointment to the ointment. Sanhuang lotion and cork cream are used to treat dry eczema. Raw ground elm, cork decoction or purslane mixture, 2% boric acid water for external cold and wet compresses. After the erosion is alleviated, use Qingdai powder or egg butter external cream to treat seborrheic and eczema. Oral medicine is mainly for clearing heat, detoxifying and cooling blood.

6. Physical therapy

For chronic refractory eczema, ultraviolet radiation therapy can be used.

Infant eczema prevention care

1. The child should take a bath every day to keep the skin clean and moist, but the water temperature should not be too high. Use chemical bath products as little as possible, and avoid irritating external drugs. Thicker crusts should be moistened with sterilized sesame oil before wiping off the crusts.

2. Try to avoid scratching and friction. Wear loose clothing and not too thick. Wear cotton clothes and avoid contact with woolen and chemical fiber clothing.

3. Breastfeeding, mothers should not eat spicy, hot, fishy, beef, mutton and other hair; children should not add shrimp, crab, fish and other allergic foods.