Doctor Q&A Support Group

Sharing Treatment for Eczema Children

Eczema Treatment for Children Dr Lynn Chiam dermatologist Singapore
Elomet ointment

Last Friday’s eczema support group session with Dr Lynn Chiam was a fruitful one – the topic was Treatment for Kids’ Eczema and we had pizza and chicken wings for lunch at the National Skin Centre Singapore!
Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Children & Adult Skin Hair Laser Clinic, Singapore.

Eczema Tips for Children

1. Moisturizing within 3 Minutes After Shower

This is inline with Dr Jennifer Shu’s tip here, so it appears that it’s an international recommended practice. Dr Lynn shared that should it be difficult to do so, or if skin is still dry, wet wrap can be implemented. For practical purpose, should the child not be able to tolerate wet wrap overnight, instead implement at least an hour, 5 times a week. Even a dry wrap will retain moisturizer better for the skin.

2. Removing House Dust Mite (if it is an allergen for your child)

Dust mite can be killed either by extreme cold or heat – so wash bedsheet in at least 60 deg C water (read this post) and for stuff toys, freezing them may help decrease the amount of dust mite as they are affected by extremes of temperature. Dr Lynn recommended sunning mattresses and changing mattress once per year, i.e. don’t get a thick and very expensive one. Remove carpets.

3. Use of Topical Steroid – Don’t be Steroid-Phobia

I shared that there is a lot of fear out there among parents on using even the mildest steroid cream, and I’ve heard of increasing number of children hospitalized for infections due to fear of using steroid. Read more here on ‘Is Steroid Cream Safe?’. Dr Lynn explained 4 side effects of topical steroid (i) skin thinning (ii) easy bruising, (iii) fragile blood vessels and (iv) excessive hair growth. However, these can be avoided if patients ensure they use (1) the right steroid (2) at the right part of skin and (3) for the right amount of time. 

Topical Corticosteroid Withdrawal Children

Read this interview with Professor Hugo where we go through the review paper conducted by National Eczema Association on Topical Corticosteroid Withdrawal

For anyone who emailed me (and we’re talking many!) who ask if steroid cream is safe because they’ve read about the side effects (which further reinforces FEAR spread like FIRE), you know my reply is the side effects of MISUSE should not be confused with Right Use. There are also many who have an agenda for propagating fear – to sell a steroid-alternative. Again, there is no need to use one and not the other. You can use steroid safely to treat flare-ups and skin inflammation, while at the same time, moisturize, wet wrap, have healthy diet, healthy lifestyle, distract your child, protect their skin, covering their fingers..

Side effects of MISUSE should not be confused with Right Use

Dr Lynn shared that steroid treatment should be used pro-actively, to treat skin inflammation even after the rash disappear, and this is also consistent with what Dr Bridgett shared in this post. Protopic can be used for maintenance, and I’ve clarified with Dr Lynn that the stinging sensation that some experienced with Protopic will not be manifest as rashes. For more on Protopic, see here.

4. On Oral Steroid

This is usually a treatment for severe active cases, not lightly prescribed due to its side effects of osteoporosis, stunting growth and increased vulnerability to infection. Tomorrow’s post is on prednisolone, and you can also refer to previous post on cyclosporine.

5. This is my afterthought – Don’t Jump from Fear to Fire

I’ve shared earlier that Fears spreads like Fire, and I like to remind parents not to jump from fear into fire – for instance:

Is someone telling you not to use steroid but something natural? If so, do ask them and search Pubmed for studies. I’m not against natural and I’m not against any parent wanting to try something natural. Do check 1. It’s safe to consume/apply, 2. Keep up the standard treatment.

Is someone telling you that a steroid cream is not working and that the flare is caused by it? Think back – did your child have rashes before the steroid? and Dr Lynn shared that each steroid cream has its own molecular structure, suited for different purpose. You may wish to work with your doctor on another cream.

Is someone telling you their skin recovers after doing a,b,c and d? Ask them, did they do a,b,c and d while applying the steroid?

Is your doctor (I really hope not) telling you that established clinically trialed cream is no good and their own concoction is better? I do not know if it is/not, how would anyone know if it’s kept a secret, even without a medical name. If it doesn’t work for your child, it’d be impossible for the next doctor to understand what your child has been prescribed and how the skin reacted.

This is a very long summary of the discussion. But as you can see, I’m really AGAINST people who spread fear of steroid – again, I’m not saying steroid is the only way, I’m saying it has its place and fear shouldn’t be propagated for personal means.

5 replies on “Sharing Treatment for Eczema Children”

Thanks, Mei, for your levelheadedness. Topical steroids have been around for years and the side effects are generally well known–and minimal, in most cases. The idea of being afraid of lower-strength hydrocortisone, if indeed that is what people are afraid of, is absurd.

There is a whole spectrum of topical steroids and, true, the ones at the higher end deserve respect and should be used with caution. But most people are not using the strong stuff. You just have to be informed about what you are using–for example check a chart like this one.

Thanks for your comment, I always tell my hubby that there’s another eczema parent on twitterverse worth respect, and that’s an eczema dad (and you)!


When atopic eczema is “always there”, coming and going but never clearing altogether, at it’s best the skin can look “lichenified”. This thickened skin is the sign of chronic eczema and needs more than emollient and topical steroid: it needs habit reversal for habitual scratching. Then optimal emollient use – before as well as after washing – and correct topical steroid use – continuing beyond the look good point – clears the eczema and changes life. We call it The Combined Approach. Watch the slideshow at

It drives me nuts when parents give others advice that start w/ “don’t do this because of that…” I tend to give unsolicited advice but I always like to phrase it so that I’ll suggest something that I think will work but I’ll support it with “it works well for me, but every child is different.” I think everyone should keep an open mind and stay educated to make the best decision for his/her own child.

Thanks, I perfectly understand that everyone will share passionately about what works for them, but there is absolutely no need to propagate fear, and particularly not for profit.

Thanks for commenting and support,

Your sharing will help others!