“Eczema in Children: Best Practices for Emollients and Corticosteroids in Primary Care” is a collaborative post.
Atopic dermatitis (eczema) in children requires a thoughtful, evidence‑based approach that blends daily barrier protection with anti‑inflammatory treatment during flare‑ups. In primary care, understanding both the principles and practical application of emollients and topical corticosteroids is vital for achieving control, reducing harm, and supporting families.
Emollients: The Foundation of Management
Emollients are the cornerstone of eczema care, recommended as first‑line therapy even when the skin appears clear. They reduce transepidermal water loss, restore the skin barrier, and decrease itch and infection risk.
- Use leave‑on emollients liberally over the whole body at least twice daily—preferably after bathing and during the day. Aim for prescription amounts of 250–500 g per week depending on severity.
- Choose unperfumed, child‑friendly preparations, and consider a lighter cream or lotion for daytime and a greasier emollient overnight for hydration and comfort.
- Teach caregivers the “smooth, don’t rub” technique to minimise irritation and improve absorption—cover gentle strokes rather than vigorous rubbing.
Corticosteroids: Applying Safely & Effectively
Topical corticosteroids (TCS) remain first‑line during inflamed eczema flares. Recent evidence clarifies optimal potency and frequency, reducing parental fears and improving outcomes.
- Once‑daily application is as effective as twice daily for both flares and maintenance treatment, reducing side‑effect risk without compromising efficacy.
- Proactive intermittent use, such as applying 2 consecutive days per week on areas prone to recurrent flare-ups, can significantly reduce relapse risk with minimal steroid exposure.
- Tailor potency to disease severity and body site:
- Mild potency (e.g. hydrocortisone 1%) for mild eczema or facial use
- Moderate for moderate flares on trunk and limbs
- Short-term potent steroids (up to 7–14 days) for severe flares or lichenified skin—but avoid potent steroids on face unless under specialist supervision.
Application Technique & Sequence
- Apply topical corticosteroid to affected areas first, especially while skin is still slightly damp from bathing.
- Wait at least 30 minutes before applying emollient over the same area to prevent dilution of the steroid and improve absorption.
- Use the Fingertip Unit (FTU) guide to instruct parents on appropriate quantities—one FTU covers approximately the size of an adult hand; adjust amounts based on the child’s age and affected body surface area.
Educating Families & Supporting Adherence
- Address parental concerns around “steroid phobia” by explaining that short-term, correctly applied TCS are safe in children—and that under-treatment often leads to worse eczema and future higher‑potency need.
- Provide written or visual tools, such as FTU charts or treatment plans outlining eczema flares vs clear skin phases.
- Reassure parents that maintenance emollient therapy combined with intermittent steroid use prevents flares and can minimise overall steroid exposure.
- Review therapy at least annually and adjust treatment steps as eczema control improves or worsens.
Develop Your Knowledge with Practitioner Development UK’s short CPD courses.
To gain confidence in theoretical frameworks, guidance, and patient support strategies for paediatric eczema:
- Course A: Childhood Eczema: Diagnosis, Treatment and Support
Detailed UK‑based guidance on stepped‑care management using emollients, topical corticosteroids, proactive flare prevention and family education. - Course B: Diverse Dermatology: Identifying and Treating Acute Skin Conditions in Children and Young People
Covers acute eczema flare ups among other paediatric skin conditions, emphasising diagnosis, treatment planning, use of topical therapies, and culturally sensitive support guidance.
Both courses help build a robust knowledge base to support clinical decisions and parent education in primary care.
By applying these simple, evidence‑based principles—choosing appropriate potencies, instructing correct application, and reinforcing routine emollient use—primary care providers can partner effectively with families to control paediatric eczema, reduce relapses, and improve quality of life.
References
- NIHR Evidence, 2024. Eczema in children: uncertainties addressed. Findings include that once‑daily corticosteroid use equals twice‑daily, and intermittent use prevents flares safely. NIHR Evidence. Available at: [Accessed 5 August 2025].
- Lamb, A., et al., 2022. Effectiveness and safety of lotion, cream, gel and ointment emollients for childhood eczema: a pragmatic, randomised phase 4 trial. The Lancet Child & Adolescent Health, 6(8), pp.512–522. Demonstrates equivalence across emollient types and supports prescribing large quantities for optimal barrier control. Wikipedia
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