What is the formulation for topical hydrocortisone (corticosteroid) for a 16-month-old child with atopic dermatitis (eczema)?

From the Guidelines

For a 16-month-old with eczema, I recommend using over-the-counter 1% hydrocortisone cream, applied thinly to affected areas twice daily for no more than 7 consecutive days, as it is a low-potency topical corticosteroid suitable for infants and young children. According to the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1, infants and young children with AD should be treated with less potent TCSs due to the increased risk of adrenal suppression from potent TCSs. Some key points to consider when using hydrocortisone cream on a 16-month-old with eczema include:

• Apply the cream after bathing when the skin is slightly damp
• Follow with a fragrance-free moisturizer to lock in hydration
• Limit the total amount used to no more than 30 grams per week
• Cover only the inflamed areas and avoid the face, genitals, and skin folds unless specifically directed by a pediatrician
• Monitor for signs of infection, such as increased redness, warmth, oozing, or crusting, and consult a doctor immediately if the eczema doesn't improve within a week, worsens, or if the skin becomes infected. Hydrocortisone works by reducing inflammation, itching, and redness by suppressing the immune response in the skin, making it an effective treatment for eczema flare-ups 1.

From the FDA Drug Label

Active Ingredient Hydrocortisone 1% Directions for itching of skin irritation, inflammation, and rashes: ... children under 2 years of age: ask a doctor

The formulation for topical hydrocortisone is 1% hydrocortisone. For a 16 month old with eczema, the FDA recommends to ask a doctor for guidance on use, as the child is under 2 years of age 2 2.

From the Research

Formulation for Topical Hydrocortisone

For a 16-month-old child with eczema, the formulation for topical hydrocortisone can be considered based on the following factors:

• Potency of the topical corticosteroid
• Frequency of application
• Duration of treatment

Potency of Topical Corticosteroid

• Moderate-potency topical corticosteroids probably result in more participants achieving treatment success compared to mild-potency topical corticosteroids 3
• Potent topical corticosteroids probably result in a large increase in the number achieving treatment success compared to mild-potency topical corticosteroids 3
• However, there is uncertain evidence to support any advantage of very potent over potent topical corticosteroids 3

Frequency of Application

• Applying potent topical corticosteroids only once a day probably does not decrease the number achieving treatment success compared to twice daily application 3
• Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 4

Duration of Treatment

• No trials were identified that compared longer versus shorter-term duration of application for induction of remission 3
• Topical corticosteroids weekend (proactive) therapy probably results in a large decrease in the likelihood of a relapse compared to no topical corticosteroids/reactive application 3
• Intermittent use of topical corticosteroids probably results in little to no difference in risk of growth abnormalities, non-skin infections, impaired vaccine response, and lymphoma/non-lymphoma malignancies 5

Safety Considerations

• Local adverse events, such as abnormal skin thinning, were not well reported and came largely from low- or very low-certainty, short-term trials 3
• The risk of adverse effects increases with prolonged use, a large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals 4
• A 2-week single course of topical treatment with a mildly potent steroid can cause transient epidermal thinning 6
• Skin thinning was not increased with short-term use of any topical steroid potency, but skin thinning was reported in 6/2044 (0.3%) participants treated with longer-term (6-60 months) topical steroids 7

Key Points

• Moderate-potency topical corticosteroids are probably more effective than mild-potency topical corticosteroids
• Applying potent topical corticosteroids once a day is probably as effective as twice daily application
• Topical corticosteroids weekend (proactive) therapy is probably better than no topical corticosteroids/reactive use to prevent eczema relapse
• Intermittent use of topical corticosteroids is probably safe for up to 5 years
• Local adverse events, such as skin thinning, are a concern with long-term use of topical corticosteroids 3, 5, 4, 6, 7