H O ^ HH
n
s
t/3
2
a w > 73
HH I/)
M
Fig 2.23 Antihistamines
Do not use in atopic eczema
Topical steroids for children, infants and babies Understandably the concern over both local and systemic side-effects increases with the youth of the patient. Although very young patients have skin that may be very responsive to topical steroids, there is also the attendant fear of increased risk of side-effects. Such concern is generated by common clinical experience. If however all aspects of The Combined Approach are taken into account the same principles in topical steroid use are applicable whatever the age of the patient. As with all patients, close monitoring of the healing process is relevant. Overall, less rather than more topical steroid use will result from The Combined Approach in children, just as with adults. Inadequate treatment of children, infants and babies leads to chronic disability. When this is profound, the effect on development and growth can be as alarming as the retardation caused by systemic side-effects. There is little evidence that systemic effects of topical steroids stunt growth in children. More important may be the stunting effect of regularly interrupted sleep in chronic eczema, as growth hormone is usually released in sleep. When lack of sleep complicates long-standing atopic skin disease through itch and scratching, there is a related reduction in growth hormone secretion. If the child also suffers from severe asthma, hypoxia is an additional factor in stunting growth.
2.3 Other Treatments Antihistamines Topical antihistamines should not be used as there is considerable risk of sensitisation.
32
Childhood: promethazine trimeprazine
Oral antihistamine preparations are frequently prescribed but the results can be disappointing, despite the theoretical logic behind their use. In childhood a sedating antihistamine at night can be helpful, though it may be the sedative rather than the antihistaminic effect that is important. Promethazine and trimeprazine are often used.
Adulthood: hydroxyzine cetirizine
For adults, hydroxyzine or its non-sedating derivative cetirizine may be prescribed. That much scratching in chronic eczema is habitual and not provoked by itch may help explain the unsatisfactory results of antihistamine treatment. See Fig 2.23.