Concerns About Steroid Use in Infants with Eczema

Medication Issues for Infants

Hello Dr.
Hsiao, my daughter is currently seven months old and has a predisposition to atopic dermatitis.
Recently, her skin condition worsened (with rashes all over her body), so we took her to the hospital for a consultation.
After the examination, the doctor prescribed Kidsolone (an oral corticosteroid), Cyproh solution, and Meikang ointment.
I am concerned about the potential negative effects of using oral corticosteroids in infants.
Is there a risk of rebound effects from corticosteroid use? Will long-term use of these medications have adverse effects? I am worried that after using these medications, stopping them might lead to even bigger problems in the future.
Additionally, the doctor also prescribed Betamethasone and calcium carbonate tablets, which I find a bit confusing since the doctor did not mention the purpose of these during the consultation, and I didn't have the opportunity to ask.
I would appreciate your clarification on these matters.
Thank you.

Mia, 20~29 year old female. Ask Date: 2016/04/21

Dr. Xiao Kaiwen reply Pediatrics

Short-term use of low-dose oral corticosteroids is unlikely to cause rebound effects and will not have significant impacts on infants.
Some studies suggest that consuming specific probiotics may be beneficial for atopic dermatitis.
Calcium carbonate may be added as an antacid due to concerns that oral corticosteroids could irritate the stomach.

Reply Date: 2016/04/21

More Info

When it comes to the use of steroids in infants, particularly for conditions like eczema, there are several important considerations to keep in mind. Your concerns regarding the use of oral steroids, such as Kidsolone, and topical treatments like Cyproh Sol'n and Meikang ointment are valid, especially given the potential side effects and long-term implications of steroid use in young children.

1. Short-term vs. Long-term Use of Steroids:
Oral steroids can be effective in managing severe eczema flare-ups by reducing inflammation and suppressing the immune response. However, the use of steroids, particularly in infants, should generally be limited to short-term treatment due to the risk of side effects. Short-term use of low-dose oral steroids is usually considered safe and is unlikely to cause significant adverse effects. However, prolonged use can lead to complications such as growth suppression, weight gain, and increased susceptibility to infections.

2. Rebound Effect:
One of the concerns with steroid use is the potential for a rebound effect, where symptoms may worsen after discontinuation of the medication. This is particularly noted with topical steroids, but it can also occur with oral steroids if they are stopped abruptly after long-term use. To mitigate this risk, doctors often recommend tapering the dose rather than stopping it suddenly.

3. Side Effects of Oral Steroids:
In infants, the side effects of oral steroids can include mood changes, increased appetite, and potential impacts on growth and development. While short-term use is generally safe, it is essential to monitor your child for any adverse reactions. If your child is on steroids for an extended period, regular follow-ups with your pediatrician are crucial to assess their growth and overall health.

4. Additional Medications:
Regarding the other medications prescribed, such as the calcium carbonate (碳酸鈣錠), this is often used to prevent stomach irritation that can occur with steroid use. It acts as an antacid and can help protect the stomach lining. The other medication, Cyproh Sol'n, is likely a topical treatment aimed at managing skin symptoms.

5. Alternative Treatments:
In addition to steroids, there are alternative treatments for eczema that may be considered. These include moisturizers, topical calcineurin inhibitors (like tacrolimus), and antihistamines for itching. Some studies suggest that probiotics may also help in managing eczema symptoms, although more research is needed in this area.

6. Monitoring and Follow-Up:
It is essential to maintain open communication with your healthcare provider regarding your child's treatment plan. If you have concerns about the medications prescribed, including their necessity and potential side effects, do not hesitate to discuss these with your pediatrician or a dermatologist specializing in pediatric skin conditions. They can provide guidance tailored to your child's specific situation.

In conclusion, while the use of steroids can be effective for managing eczema in infants, it is crucial to use them judiciously and under medical supervision. Regular monitoring and a comprehensive approach to treatment, including non-steroidal options, can help manage eczema effectively while minimizing potential risks associated with steroid use.

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