Managing Eczema in Preterm Infants: Medication Concerns and Solutions

Medication issues for atopic dermatitis?

Hello, thank you very much for this channel to assist.
My son is a preterm infant and is currently almost five months corrected age.
He has been experiencing an outbreak of atopic dermatitis for over a month, and we are using corticosteroids and antihistamines.
I have the following main questions:
1.
We only apply the medication when the rash is red, but since it tends to flare up repeatedly, we end up applying it again when it becomes red.
Is it acceptable to continue using it this way?
2.
The doctor mentioned that if he continues to scratch after taking medication, we can increase the dosage of the liquid medication (he currently takes it after breakfast, lunch, and dinner, as well as before bed).
He weighs 7.2 kg, and he is currently taking 1 ml of the medication.
I am unsure if we can or should increase the dosage.
Additionally, he is still on antiepileptic medication, but his EEG shows no significant discharges now (he previously had more seizures when taking the antihistamine, but not this time).
The main issue is that he has unstable sleep at night and seems very itchy.
Thank you.

Dai Bo La, 30~39 year old female. Ask Date: 2018/05/08

Dr. Xiao Kaiwen reply Pediatrics

Atopic dermatitis is considered one of the most complex allergic diseases and is recognized as one of the most challenging to manage.
Bathing should be done with plain water, avoiding high temperatures.
Regular application of moisturizer is essential.
Breastfeeding or using hypoallergenic formula is recommended, and introducing solid foods should be done in small, varied amounts.
In cases of severe acute flare-ups, corticosteroid ointments may be applied, but they should not be used for extended periods or relied upon excessively.
If there is a secondary bacterial infection, antibiotic ointments are necessary.
This topic cannot be fully explained in just a few sentences, so please consult a trusted pediatrician or dermatologist who specializes in this area for advice and long-term follow-up.
Hydroxyzine is primarily used for itching and should also be used during acute phases, with an emphasis on maintenance rather than long-term dependence.
For a weight of 7.2 kg, the dosage may be increased to 1.5 cc per dose.

Reply Date: 2018/05/08

More Info

Managing eczema in preterm infants can be particularly challenging due to their sensitive skin and the potential risks associated with medication use. In your case, it sounds like your son, who is a preterm infant and currently corrected to five months, has been experiencing an outbreak of atopic dermatitis (eczema) for over a month. You are using topical corticosteroids and an antihistamine (likely referring to a medication like "希普利敏," which may be a brand name for an antihistamine). Here are some considerations and recommendations based on your questions and the current medical understanding of eczema management in infants.

1. Use of Topical Corticosteroids
Topical corticosteroids are commonly prescribed for managing eczema flare-ups. It is generally acceptable to apply these medications when the skin becomes red and inflamed. However, it is important to use them judiciously to avoid potential side effects, such as skin thinning or tachyphylaxis (where the skin becomes less responsive to the medication over time).
If your son’s eczema is recurrent and you find yourself needing to apply the corticosteroid frequently, it may be beneficial to consult with your pediatric dermatologist. They may recommend a more proactive approach, such as using a lower potency steroid regularly to maintain skin hydration and prevent flare-ups, rather than waiting for the skin to become inflamed.

2. Adjusting Antihistamine Dosage
Regarding the antihistamine dosage, it is crucial to follow the prescribing physician's guidance. Antihistamines can help alleviate itching, which is a significant concern for infants with eczema. If your son is currently taking 1 ml of the medication and is still experiencing significant itching, it may be reasonable to discuss with your healthcare provider the possibility of adjusting the dosage.
However, it is essential to consider his overall health, especially since he is on antiepileptic medication. The interaction between medications can be complex, and any changes should be made under the supervision of a healthcare professional who is familiar with his medical history.

3. Managing Itch and Sleep Disruption
The itch associated with eczema can significantly disrupt sleep, leading to further distress for both the infant and the caregivers. In addition to medications, consider implementing a comprehensive skincare routine that includes:
- Moisturizers: Regular application of emollients can help maintain skin hydration and barrier function. Look for fragrance-free, hypoallergenic products specifically designed for sensitive skin.

- Bathing Practices: Short, lukewarm baths followed by immediate application of moisturizer can help lock in moisture. Avoid harsh soaps and opt for gentle, moisturizing cleansers.

- Environmental Control: Keep the infant's environment cool and avoid known irritants, such as certain fabrics, detergents, or allergens that may exacerbate the eczema.

4. Monitoring and Follow-Up
Given your son’s history of being a preterm infant and his ongoing medical needs, regular follow-up with his healthcare team is essential. They can monitor his eczema, assess the effectiveness of the current treatment regimen, and make necessary adjustments.
In summary, managing eczema in preterm infants requires a careful balance of medication use, skincare routines, and environmental management. Always consult with your healthcare provider before making any changes to medication dosages or treatment plans, especially considering your son's unique medical background. Your proactive approach to seeking information and support is commendable, and it is essential to continue advocating for your son's health and comfort.

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