Comparing Eczema Products for Kids: Effectiveness and Safety Insights for Parents

If your child has eczema, as a parent you’ll need to know how eczema products differ. This isn’t usually very clear when you start, and the multitude of options doesn’t make it easier. At our Parramatta pharmacy, parents often come in wondering if their over-the-counter (OTC) cream is sufficient, and whether they should switch to something stronger.

The thing is, not all eczema products are designed to do the same thing. OTC creams mostly aim to rebuild and protect the skin barrier, while prescription medications like topical steroids and topical calcineurin inhibitors (TCIs) target inflammation at a deeper level. This isn’t a case where there is a clear hierarchy of superiority from product to product. Each plays an important role, and an essential one at that.

Both safety and effectiveness are well-documented for common eczema treatments, assuming they are used as intended. Unfortunately, improper use occurs more than it should, probably stemming from a misunderstanding of how eczema products work. Hence, we’ll compare some of the most common types of eczema treatments so that you have a deeper understanding of their contribution. As a parent, if you understand the intentions of each treatment category, it’s much easier to make informed decisions about your child’s skin issues.

What Are the Common Types of Eczema Products for Children?

Treating eczema falls under numerous different umbrellas. In fact, proper eczema management often includes products that are good for general skin health but aren’t eczema-specific. For the sake of scope, we’ll compare 3 common eczema treatments, and many kids are likely require at least 2 of the types listed below:

• Emollients and moisturisers (OTC) – Broadly speaking, these are non-prescription creams and ointments used to hydrate the skin and strengthen its barrier.
• Topical corticosteroids (prescription) – These are medicated creams that calm inflammation and reduce itching during flare-ups. Lower strength non-prescription topical steroids also exist.
• Topical calcineurin inhibitors (prescription) – A non-steroidal prescription option. They regulate immune responses in the skin, which is useful when steroids aren’t suitable.

While we are going to compare these products, remember that these aren’t competing products. They differ in use case, but complement each other. For instance, emollients form the base of eczema management, and prescription treatments step in when inflammation can’t be controlled by hydration alone.

How Do Emollients Work and Are They Enough?

Emollients are the foundation of any good eczema routine. They work by creating a barrier over the skin, locking in moisture and protecting against environmental triggers like soaps, temperature changes, or allergens. In doing so, they help repair the damaged skin barrier that makes eczema so persistent in children.

These creams are used daily, often multiple times a day. And when a good emollient is used consistently, it can often prevent the dryness and micro-cracks that trigger inflammation. They’re also generally very safe, even for infants. Of course, everyone’s skin is different and has its preferred type of emollient. You also have to consider the thickness of an emollient in relation to your child’s skin type and the seasonal temperatures.

For mild eczema, emollients can do most of the heavy lifting. Consistent use reduces itching, prevents flares, and maintains comfort for your kid. If a flare-up does occur (aka. redness, swelling, patches that are hot to touch), prescription options might be necessary. But emollients do a great job at keeping flare-ups at bay, while also providing the base layer of hydration needed for prescription options to work as intended.

How Do Emollients Compare to Prescription Treatments?

As you can tell, prescription creams aren’t simply “stronger versions” of what’s available over-the-counter. Emollients and prescription treatments serve different functions: one strengthens the skin’s defences, the other controls inflammation once it begins.

Because emollients are the frontline for prevention and daily management, you’ll be using them a lot more than any prescription treatment. They can also be used quite liberally, whereas topical steroids and TCIs require monitoring. And even when a flare-up occurs and requires prescription intervention, emollient use should continue as they complement the targeted treatments.

Overall, emollients are essential, and the existence of prescription treatments does not diminish their importance. If anything, they highlight the complementary role of OTC creams and further stress the importance of consistent skin management.

When Should Topical Steroids Be Used Over TCIs (and vice versa)?

Both topical corticosteroids and TCIs are effective at controlling eczema, but they’re not interchangeable. Each has distinct strengths, risks, and ideal use cases that we can compare directly.

When to Use Topical Corticosteroids

Topical steroids are the first-line prescription option for most eczema flare-ups. They act quickly to suppress inflammation, providing fast relief from itching and redness. The speed in which they work is one aspect that differentiates them from other treatment options.

Doctors will choose a steroid strength with your child’s age and skin sensitivity in mind. They also consider the severity of the flare-up and where it’s located.

For example, hydrocortisone might be used for mild flare-ups or facial areas, while stronger formulations such as mometasone or betamethasone are reserved for thicker skin or severe inflammation.

Corticosteroids are considered safe and highly effective when used properly. While side-effects like skin thinning or discolouration are well known, this is usually a result of prolonged, unsupervised use. Some sensitive areas of the skin aren’t really suitable for steroid use at all, but generally speaking, proper short-term treatment under medical guidance is unlikely to cause serious issues.

Nonetheless, it’s worth mentioning that over-reliance on corticosteroids without daily barrier support is a mistake that happens too often. Make sure to maintain your child’s OTC routine even during topical steroid treatment. And once flare-ups subside, the focus should shift back to consistent emollient use to prevent recurrence. If you continue to use steroids past the recommended time-frame, you’re putting your child’s skin under significant risk.

When to Use Topical Calcineurin Inhibitors (TCIs)

Topical calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) are typically introduced when:

• A child’s eczema is chronic or recurrent, requiring long-term control.
• The affected area involves sensitive skin, such as around the eyes, mouth, or genitals, where steroid use should be limited.
• Steroids have caused irritation or are no longer providing adequate control.

Unlike steroids, TCIs don’t thin the skin, making them safer for repeated use over time. They work by suppressing the overactive immune response that drives eczema, gradually reducing flare frequency. Certain side-effects like burning or tingling are often more noticeable compared to steroid treatments, but TCIs are generally well-tolerated.

As always, there are exceptions. Your doctor won’t prescribe a TCI if your child has a weakened immune system, as they work by dampening down the immune response. Similarly, TCIs should not be applied to infected skin, as it can exacerbate both bacterial and viral infections.

When compared directly to topical steroids, calcineurin inhibitors have a more moderate onset of action. But while they don’t work as fast as steroids, they’re much safer for longer periods of use. 

TCIs should not be used at the same time on the same part of the body as steroids, but that doesn’t mean these treatments aren’t complimentary. Dermatologists often recommend using TCIs after a short course of steroids, once inflammation has settled, to maintain clear skin and reduce future flares. This step-down approach is commonly used because it doesn’t overexpose the skin to corticosteroids.

In the case of emollients, they are highly recommended for liberal daily use regardless of TCI treatment. Your only concern is timing, as some TCI manufacturers suggest a 2-hour gap between applying an emollient and their product.

 

 

The Verdict

Used properly and with medical guidance, all three are safe and effective. Emollients are particularly low-risk and provide the necessary foundation for long-term eczema maintenance. The prescription options come in when more targeted relief is needed. But even these are hardly competing against each other, and are often both included within a complimentary treatment plan (albeit not at the same time on the same area of skin).

Most of the safety concerns for any of these products are easily avoided by using them as directed, and for their intended use case. As long as you keep the skin moisturised, treat flare-ups promptly, and adjust treatment under professional supervision, most cases of child eczema are well-managed. If this doesn’t seem to be enough, then it’s best to consult your GP and/or a dermatologist.