To Treat Eczema in Kids, Skip the Antibiotics

Teresa Carr
Updated

As spring gets into full swing, more children will be scratching from the unbearable itch of eczema, and many pediatricians will be writing prescriptions for antibiotics.

"Eczema can make children miserable, so it’s understandable that both doctors and parents would want to do everything possible to get symptoms under control," says Megha Tollefson, M.D., an assistant professor of dermatology and pediatrics at the Mayo Clinic in Rochester, Minn., and co-author on a 2014 clinical review on treating childhood eczema for the American Academy of Pediatrics. “But research shows that antibiotics won’t cure mild-to-moderate eczema in kids any faster than standard treatment."

A recent study involving 113 children with eczema (most under the age of 3) without symptoms of a serious infection such as fever or pus-filled sores showed that antibiotics don't help with eczema flare-ups.

The children were treated with moisturizers as well as ointments containing a corticosteroid, which helps calm inflammation and itching. In addition, half the kids were also prescribed a week’s worth of antibiotics, either a pill or topical cream.

Results, published in March in the Annals of Family Medicine, showed that all of the children, whether they received antibiotics or not, got much better in two weeks and remained stable over the next three months.

Prescribing Only When Necessary

Antibiotics shouldn’t be used when they aren’t needed because the drugs can cause side effects. For example, antibiotic creams can cause skin irritation and rashes. Oral antibiotics (pills or liquid by mouth) commonly cause diarrhea, nausea, and vomiting, Tollefson says.

“Babies and toddlers with eczema are more prone to diaper rash, and diarrhea can make it much worse,” she says.

And in rare instances, oral antibiotics can cause serious harm.

A recent study from the Centers for Disease Control and Prevention revealed that side effects from antibiotics, most commonly severe allergic reactions, are responsible for more than 65,000 children being rushed to the emergency room each year. For children younger than 5, side effects from antibiotics such as amoxicillin (Amoxil, Moxatag, and generic) and azithromycin (Zithromax, Z-Pak, and generic) are the leading cause of ER visits due to adverse drug effects.

What’s more, the overuse of all forms of antibiotics are contributing to the rise of dangerous superbugs—strains of bacteria that are resistant to multiple antibiotics. The result is a growing number of infections that are more virulent and much harder to treat.

Why Doctors Overprescribe Antibiotics

Given the risks of antibiotics, medical guidelines caution against overusing the drugs against eczema. For example, as part of the Choosing Wisely initiative (Consumer Reports is a partner), the American Academy of Dermatology recommends against using antibiotics unless the rash is infected.

So why do doctors still commonly prescribe the drugs to treat eczema in kids?

“It’s actually quite difficult to tell the difference between an eczema flare-up and a mild infection,” Tollefson says. And testing for bacteria typically doesn’t help, she says, because people often carry bacteria on their skin even when they don’t have an infection.

Doctors wind up prescribing antibiotics out of an abundance of caution, she says, to prevent a possible infection from getting worse.

"Flare-ups are going to happen," Tollefson says. But, she adds, the Annals of Family Medicine study is "reassuring" in revealing there's no need to rush to antibiotics. “In the absence of clear signs of infection, the best approach is to do a good job taking care of the skin to allow the body to heal itself,” she says.

Indications of an infection that do warrant antibiotic treatment, according to American Academy of Dermatology: honey-colored crusting on the rash, pus-filled yellow or red bumps, or sores and cracks that ooze pus. The skin may also be very red or unusually warm and, in some cases, children may run a fever.

Antibiotic ointments cause fewer side effects than oral versions but don't work as well. "We typically reserve topical antibiotics for when there are only one or two small areas affected," says Jenny Murase, M.D., assistant clinical professor of dermatology at the University of California San Francisco and a spokeswoman for the AAD. "But when the infection is widespread or affects multiple areas of the body, oral antibiotics are generally needed."

Best Ways to Manage Eczema in Kids

There’s no cure for eczema in kids, Murase says, but the good news is that some children eventually outgrow it. "Once you become a teenager, the body starts to produce more oils that can help protect the skin."

In the meantime, she says "to prevent flare-ups and infections, it's important to stay on top of daily skin care." Here are some tips:

  • Moisturize. For kids prone to eczema, apply moisturizing creams to their entire body at least once daily, even when their skin is clear. Though prescription ointments shouldn’t be used more than twice daily, you can use moisturizers as often as needed to soothe rough, dry skin. To prevent irritation, choose fragrance-free products.

  • Avoid irritants. Triggers can include scratchy clothing, tobacco smoke, scented products such as laundry soap, and extreme hot or cold temperatures.

  • Try to prevent scratching. It’s easier said than done when a young child is involved, but scratching can make itching worse and lead to infection. Keep children’s fingernails short and, if necessary, have them wear light cotton gloves at night to keep them from scratching in their sleep. Ask your doctor about an over-the-counter antihistamine pill or liquid such as diphenhydramine (Benadryl Allergy and generic) to help alleviate itching. Avoid anti-itch products that you apply to your skin such as Benadryl Itch-Stopping Cream because they can be irritating for kids with eczema.

  • Let kids enjoy bathtime. The advice used to be to limit baths to twice weekly or so to avoid drying out the skin. But Murase says that bathing can actually provide the skin with needed moisture. Soap can be drying, though. So use mild, unscented skin cleansers only on the armpits and groin and, after washing, pat the skin partly dry then apply moisturizer right away on damp skin.

  • Talk to your doctor about adding vinegar or a very small amount of bleach to bathwater. Using a cup of vinegar or a tiny amount of unscented chlorine bleach (3 tablespoons in 20 gallons of water, about a half-full standard tub) can kill bacteria on the skin that cause infections. One recent study found that children with eczema who bathed in diluted bleach water for 5 to 10 minutes twice weekly had less-severe symptoms than those who didn’t.
         Vinegar is safe, but keep in mind that bleach straight from the bottle is dangerous for kids if they swallow any or get it on their skin, so carefully follow safety precautions and keep the chemical locked away from young children. For more information on how to safely use diluted bleach baths, use this advice from the Seattle Children’s Hospital.

  • Treat the first signs of a flare-up. “People are sometimes reluctant to use prescription ointments that contain steroids on a mild rash,” says Murase. “But using those as directed, along with moisturizers, can prevent more serious symptoms.”

Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).



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