What are the treatment options for atopic dermatitis (eczema) in infants?

From the Guidelines

Infantile eczema treatment primarily involves managing symptoms and preventing flare-ups through a combination of moisturizing, topical medications, and lifestyle adjustments, with a focus on maintaining the integrity of the skin barrier and avoiding triggers, as recommended by the most recent guidelines 1. The main treatment approach includes:

• Moisturizing: Apply fragrance-free, hypoallergenic moisturizers at least twice daily, especially after bathing, to help retain skin hydration and reduce inflammation.
• Topical corticosteroids: For mild to moderate flares, use low-potency hydrocortisone 1% cream twice daily for up to 7 days, as the benefits and risks of topical corticosteroids should be explained to patients or parents to ensure proper use 1.
• Topical calcineurin inhibitors: Pimecrolimus 1% cream or tacrolimus 0.03% ointment can be used for maintenance therapy, applied twice daily to affected areas, to suppress the overactive immune response in the skin.
• Bathing: Use lukewarm water for 5-10 minutes daily, adding colloidal oatmeal or 1/4 cup of baking soda to bathwater for soothing effects, as part of a comprehensive education plan to reduce disease severity and improve quality of life 1.
• Wet wrap therapy: For severe flares, apply moisturizer and medication, then cover with damp cloth and dry layer for 2-6 hours or overnight, to provide an intensive moisturizing treatment.
• Antihistamines: For itching, use cetirizine (2.5-5mg daily for ages 6-23 months) or diphenhydramine (6.25mg every 6 hours for ages 2-5 years) as needed, to alleviate itching and improve sleep quality.
• Trigger avoidance: Identify and avoid triggers such as harsh soaps, certain fabrics, or environmental factors, and consider a trial of maternal allergen elimination if severe eczema is suspected to be related to a food allergy, with a period of reintroduction to confirm the diagnosis 1.
• Clothing: Dress the infant in soft, breathable fabrics like cotton, to reduce irritation and prevent flare-ups. These treatments work by reducing inflammation, maintaining skin barrier function, and alleviating itching, with the goal of improving symptoms, preventing flare-ups, and enhancing quality of life, as supported by the most recent and highest quality study 1.

From the FDA Drug Label

CLINICAL STUDIES Three randomized, double-blind, vehicle-controlled, multi-center, Phase 3 studies were conducted in 589 pediatric patients ages 3 months-17 years old to evaluate ELIDEL ® (pimecrolimus) Cream 1% for the treatment of mild to moderate atopic dermatitis Two of the three trials support the use of ELIDEL Cream in patients 2 years and older with mild to moderate atopic dermatitis Two Phase 3 studies were conducted involving 436 infants age 3 months-23 months

The treatment options for atopic dermatitis (eczema) in infants include:

• Pimecrolimus (ELIDEL) Cream 1% for infants 3 months and older, as supported by two Phase 3 studies 2
• However, caution is advised as the long-term safety and effects of ELIDEL Cream on the developing immune system are unknown, and the most common adverse events in infants were pyrexia, URI, nasopharyngitis, gastroenteritis, otitis media, and diarrhea 2 Note that ELIDEL Cream is not indicated for use in children less than 2 years of age, but has been studied in infants as young as 3 months 2

From the Research

Treatment Options for Atopic Dermatitis (Eczema) in Infants

The treatment options for atopic dermatitis (eczema) in infants include:

• Emollients, such as lotions, creams, gels, and ointments, which are recommended for children with eczema 3
• Topical corticosteroids, such as methylprednisolone aceponate 0.1%, which can be effective in alleviating eczema lesions and scratching severity 4
• Breastfeeding, which may reduce the incidence of eczema in high-risk infants 5
• Prebiotics, which may also reduce the incidence of eczema in high-risk infants 5

Emollient Therapy

Emollient therapy is a common treatment approach for eczema in infants, with various types of emollients available, including:

• Lotions
• Creams
• Gels
• Ointments A study comparing the effectiveness of these emollient types found no significant difference in their effectiveness, but noted that satisfaction with the emollients varied among parents and children 3

Pharmacologic Treatment

Pharmacologic treatment options, such as topical corticosteroids, may be necessary for more severe cases of eczema, and can be effective in alleviating symptoms 6, 4

• Methylprednisolone aceponate 0.1% has been shown to be safe and effective in treating eczema in infants 4

Non-Pharmacologic Treatment

Non-pharmacologic treatment approaches, such as avoiding soap and water, and using emollients to moisturize the skin, can also be effective in managing eczema symptoms 6