How to Talk to Your Child’s Doctor About Switching Atopic Dermatitis Treatments

Maybe your child has been on a specific treatment for atopic dermatitis (also called eczema) for months or even years, but now flare-ups seem to be happening more often and with greater intensity. Or a newer treatment option that looked promising simply isn't delivering the relief you'd hoped for. In either case, it may be time for a change.

"Continued eczema symptoms, including having frequent eczema flares, are signs that the current treatment is not effective," according to Jessica Hui, MD, a pediatric allergist and immunologist at National Jewish Health in Denver. "This is where working together with your healthcare professional is very important."

Here's a look at which symptoms may indicate the need to switch treatment for children with atopic dermatitis, plus questions to ask your healthcare team when evaluating treatment choices.

• Excessively dry, cracked skin
• Itching, especially if it's constant or causes breaks in the skin
• Swollen skin
• Rash, such as raised bumps that are filled with pus
• Crusting or oozing
• Thickened skin
• More skin involved than before or in different areas
• Sleep disruption due to itching
• Depression or anxiety
• Behavioral issues or trouble concentrating in school

Although a good deal of your child's information may already be in their electronic medical records, it's helpful to bring the info with you to fill any gaps, recommends Dr. Hui. That might include the following:

• Symptoms that led to a diagnosis of atopic dermatitis
• Treatment history
• Record of flares, including symptoms like rash and itching, as well as how long those flares continued before resolution
• Triggers that seem to be prominent, especially any new triggers since the last appointment

"The more information that's available about what your child is experiencing, the better it will be for your doctor, because it can help narrow down treatment options," Hui says.

In prepping for a doctor's appointment to discuss changing your child's atopic dermatitis treatment, it helps to put together a list of questions to make the most of your conversation, Hui says. Here are three top possibilities.

What Treatment Options Have Been Approved for Children?

Although this seems like an obvious question, a treatment that had not been approved for use in children at the time of your last appointment may now be an option, says Tanya Evans, MD, a dermatologist and the medical director of the skin cancer program at the melanoma clinic at MemorialCare Saddleback Medical Center in Laguna Hills, California.

"The treatments for atopic dermatitis are expanding rapidly, and that's great news because it gives us more choices than ever before," she says. "Part of that progress is seeing medications approved for younger children. For example, a treatment that might have been approved for 12 years and older initially may now be approved for children as young as 6 months. That's why it's important to ask."

Does My Child Need to Switch Completely?

If a medication isn't working effectively now but has in the past, it's possible you won't have to change meds, says Dr. Evans. In some cases, your health provider may suggest ways to make the current treatment work better.

"You may be able to stay on the same medication but change the dosage schedule or amount," she says. "Your doctor may also recommend adding something like a topical vitamin D ointment or light therapy. In some cases, it may come down to lifestyle shifts like a different bathing schedule or using a humidifier in the bedroom."

Bottom line: Just because a medication isn't completely effective on its own doesn't mean it can't be boosted through complementary treatments and lifestyle habits, she says.

What Can My Child Expect on This Treatment?

Whether the shift is a medication change or another option like an over-the-counter remedy, phototherapy, bleach baths, or wet wraps, you should get an idea of what you can expect in terms of symptom relief.

Knowing the time frame for symptom resolution and the type of progress you should see along the way helps you know whether a treatment is working, says Evans.

As you pivot toward a different atopic dermatitis treatment for your child, it's important to keep in mind that it may take some time to find the right option.

"Even though there are many choices available to us for treatment, even for kids, there can be some trial and error as we navigate to what works best," says Hui. "Generally, when a medication is used as prescribed, you will see improvement within days to weeks. If there isn't resolution of symptoms after that time frame, you may need to go back to your health provider to talk about different treatment options."

Much as you would with symptom flares, you should keep track of changes in your child’s condition with the new treatment, including progress and any side effects, adds Huang. Follow your doctor's instructions for when to reconnect about the new treatment. Usually, your healthcare provider will want you to check in after a few weeks to see if a treatment is effective, she says.

• Even if a child has been on the same atopic dermatologist medication for years, you may need to make a change if flares are worsening.
• Write a list of questions for your next dermatology appointment so you can get your concerns about switching your child's meds addressed.
• Ask about a time frame for relief, so you know how long your child may have flares and when it might be apparent a new treatment is not effective.