Managing Eczema Around the Eyes: Medication Guidance for Parents

Eyelid dermatitis - medication consultation (Ganderson)

A 14-year-old child has redness, swelling, and scaling around the eyes, with some exudate.
Initially, they were taken to an ophthalmologist who prescribed "Erythromycin" and advised that if there was no improvement, they should see a dermatologist.
During this period, the symptoms fluctuated, sometimes completely resolving and at other times reappearing.
After about two months, they were taken to a dermatologist who diagnosed it as eczema.
The doctor prescribed both oral and topical medications, emphasizing that the ointment should be kept away from the eyes, although a small amount accidentally getting into the eyes would not be a major concern.
The medications prescribed include: 1.
Amoxicillin (500mg) 2.
Pelonine 3.
Magnesium Oxide 4.
Gentasone cream (topical).
I noticed in the package insert that it states "Contraindications" include: this product should not be applied to the eyes or around the eyes.
Should this medication still be used as prescribed by the dermatologist, or is it a concern due to the warnings in the insert? I am worried that using it could cause harm.
Thank you.

cfy, 40~49 year old female. Ask Date: 2022/09/18

Dr. Wu Yuxin reply Dermatology

This issue should be discussed with the physician who prescribed your medication.
I do not understand your medical condition and am unable to provide you with an answer.

Reply Date: 2022/09/18

More Info

Managing eczema around the eyes, especially in children, requires careful consideration due to the sensitivity of the area and the potential for complications. In your case, it seems that your child has been experiencing recurrent symptoms of redness, swelling, and flaking around the eyes, which has been diagnosed as eczema or dermatitis by the dermatologist.
The medications prescribed include Amoxicillin, Pelonine, Magnesium Oxide, and Gentasone cream. While Amoxicillin is an antibiotic that can help with secondary bacterial infections, the focus here is on the topical treatment, Gentasone cream, which contains a corticosteroid. Corticosteroids are commonly used to reduce inflammation and itching associated with eczema. However, it is crucial to use them cautiously around the eyes due to the risk of side effects, such as increased intraocular pressure, cataracts, or skin thinning.

The warning on the Gentasone cream packaging about avoiding application near the eyes is significant. While it may be safe to apply a small amount around the eye area, it is essential to avoid direct contact with the eyes themselves. If the cream accidentally gets into the eyes, it could potentially cause irritation or other complications. Therefore, it is advisable to apply the cream carefully, using a minimal amount and ensuring it does not enter the eye.

Given the recurrent nature of your child's symptoms, it may be beneficial to follow up with the dermatologist to reassess the treatment plan. If the eczema is not responding adequately to the current medications, the doctor may consider alternative treatments, such as:
1. Topical Calcineurin Inhibitors: These are non-steroidal medications that can be used for sensitive areas like the eyelids. They help reduce inflammation without the side effects associated with long-term steroid use.

2. Moisturizers: Regular application of emollients can help maintain skin hydration and barrier function, which is crucial in managing eczema.

3. Allergy Testing: If the eczema is persistent, it may be worthwhile to investigate potential allergens or irritants that could be triggering the flare-ups.

4. Lifestyle Modifications: Identifying and avoiding triggers, such as certain soaps, detergents, or environmental factors, can also help manage symptoms.

5. Oral Medications: In some cases, oral corticosteroids or antihistamines may be prescribed for severe flare-ups or to manage itching.

In conclusion, while it is essential to adhere to the dermatologist's instructions, it is equally important to be cautious with medications around the eyes. If there are any concerns about the safety of using Gentasone cream, or if symptoms persist or worsen, do not hesitate to consult the dermatologist for further guidance. They can provide tailored advice based on your child's specific condition and needs. Always prioritize safety and seek professional advice when in doubt about medication use, especially in sensitive areas like the eyes.

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