Emergency Departments Often Use Outdated Treatments for Kids’ Atopic Dermatitis
Why this matters
When a child’s eczema (also called atopic dermatitis) flares, many parents head to urgent care or the emergency room. A recent poster presented at the Revolutionizing Atopic Dermatitis (RAD) conference looked at how emergency physicians treat these pediatric flares and found that care in the ER often doesn’t match current dermatology guidance.
What the researchers looked at
Investigators used Epic electronic health record data to see what medicines were being prescribed in emergency departments for kids with atopic dermatitis flares. Christopher Bunick, MD, PhD, an associate professor of dermatology at Yale School of Medicine, shared the poster’s findings and put them in context for dermatology care.
What they found
The most commonly prescribed treatments in the emergency setting were:
- Weak topical corticosteroids — creams or ointments with low-strength steroids applied to the skin.
- Oral corticosteroids — steroid pills taken by mouth.
- Oral antihistamines — allergy pills such as cetirizine or diphenhydramine.
About one in five children in the study received an oral corticosteroid during their ER visit.
Why that raises concern
Current dermatology guidance, including recommendations from organizations like the American Academy of Dermatology, is moving away from routine or prolonged use of systemic (oral) corticosteroids for atopic dermatitis when possible. These pills can cause safety problems if used for a long time and often lead to rebound flares when stopped.
In this context, “long-term” oral steroid use was defined as continuing treatment for more than 30 days.
Dermatologists have also stepped away from using oral steroids for severe psoriasis flares because they aren’t a safe, effective long-term option. The same safety and relapse concerns apply to using them for eczema flares in children.
What about antihistamines?
The poster also showed frequent use of oral antihistamines for atopic dermatitis. According to Bunick, these medicines generally do little to reduce the skin inflammation of eczema, and they are often poor at relieving the itch that comes from atopic dermatitis.
Where the disconnect may be
These findings suggest a gap between what dermatology specialists recommend and what happens in emergency and urgent care settings. Newer, nonsteroidal topical treatments and clearer guidance about when to avoid systemic steroids aren’t always reaching clinicians outside dermatology.
Improving communication and sharing practical protocols with ER and urgent care teams could help patients get treatments that better match current evidence.
What this means for parents and caregivers
If your child needs urgent care for an eczema flare, it’s reasonable to ask the treating clinician about the plan: why a particular medicine is being used, how long it will be needed, and whether a skin-directed (topical) approach or a follow-up with a dermatologist is recommended.
Treatment choices depend on how bad the flare is, other health issues, and how often flares occur. Always discuss options with the clinician who knows your child’s history.
When to see a doctor right away
Seek immediate medical attention if your child’s eczema shows signs of infection (increasing redness, warmth, pus, swelling), severe pain, bleeding, rapid spreading, high fever, or if you’re unsure what’s causing sudden worsening. For routine flares, make sure there’s a plan for follow-up care with your primary care provider or a dermatologist.
Tracking visible changes
Keeping photos or a brief diary of the rash can help you and your clinician see whether a treatment is working or if the rash is changing. This can be useful when preparing for a dermatologist visit.
Disclaimer: This article summarizes findings presented at a medical conference and expert commentary. It is for informational purposes and is not medical advice. Treatment decisions should be made with your child’s doctor or a dermatologist.
Sources
- Revolutionizing Atopic Dermatitis (RAD) conference poster presentation; analysis of Epic electronic health record prescribing patterns. (Source: presentation and commentary by Christopher Bunick, MD, PhD)
- DiRuggiero D, DiRuggiero M. Beyond skin deep: the systemic impact of topical corticosteroids in dermatology. J Clin Aesthet Dermatol. 2025;18(1-2 Suppl 1):S16-S20. https://jcadonline.com/beyond-skin-deep-the-systemic-impact-of-topical-corticosteroids-in-dermatology/
- Gregoire ARF, DeRuyter BK, Stratman EJ. Psoriasis flares following systemic glucocorticoid exposure in patients with a history of psoriasis. JAMA Dermatol. doi:10.1001/jamadermatol.2020.4219. https://pmc.ncbi.nlm.nih.gov/articles/PMC7675213/