What is a safe and effective topical treatment for atopic dermatitis on the face in pediatric patients?

From the Guidelines

Topical corticosteroids, such as hydrocortisone 1%, are the first-line treatment for atopic dermatitis on the face in pediatric patients, but non-steroidal alternatives like pimecrolimus (Elidel ointment 1%) or tacrolimus ointment (Protopic 0.03%) are preferred for long-term use due to their safety profile and efficacy in reducing inflammation without causing skin atrophy 1. When considering treatment options, it's essential to balance efficacy and safety concerns, as the facial skin in children is thin and more susceptible to steroid-related side effects.

• Apply a thin layer of topical corticosteroids to affected areas twice daily for 7-14 days during flares.
• For maintenance therapy after the flare resolves, switch to non-steroidal alternatives like pimecrolimus (Elidel ointment 1%) or tacrolimus ointment (Protopic 0.03%) to avoid steroid-related side effects.
• Always combine medication with gentle skincare: use fragrance-free, hypoallergenic moisturizers at least twice daily, wash with mild, soap-free cleansers, and avoid known triggers.
• For severe or persistent cases, consult a dermatologist for possible adjustment in treatment, and consider adjunct therapy such as oral antihistamines, wet wrap, or psycho-behavioral therapy as needed 1. The treatment algorithm should be stepwise, with consideration of the patient's age, disease severity, and treatment response, as outlined in the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 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 About 75% of patients had atopic dermatitis affecting the face and/or neck region. At endpoint, based on the physician’s global evaluation of clinical response, 35% of patients treated with ELIDEL Cream were clear or almost clear of signs of atopic dermatitis compared to only 18% of vehicle-treated patients.

Pimecrolimus (ELIDEL) Cream 1% is a safe and effective topical treatment for atopic dermatitis on the face in pediatric patients, particularly those 2 years and older with mild to moderate atopic dermatitis 2.

• Key benefits include reduction in erythema, infiltration/papulation, and improvement in pruritus.
• Treatment response was seen by day 15, with significant improvement in key signs of atopic dermatitis.

From the Research

Topical Treatment Options for Atopic Dermatitis on the Face in Pediatric Patients

• Topical corticosteroids are considered a first-line therapy for atopic dermatitis in pediatric patients, including those under 2 years old 3.
• Topical calcineurin inhibitors, such as pimecrolimus, may also be used in infants as young as 3 months 3.
• For children and adolescents over 2 years old, topical corticosteroids and topical calcineurin inhibitors are both considered effective and safe options 3, 4.
• Emollients are also recommended as a cornerstone of treatment for atopic dermatitis in all age groups 3.

Cost-Effective Options

• Topical corticosteroids are generally considered a cost-effective option for atopic dermatitis treatment 4.
• Topical calcineurin inhibitors, such as tacrolimus, may be more expensive than topical corticosteroids, but are still considered a safe and effective option 5.
• The cost of systemic therapies, such as dupilumab and JAK inhibitors, can be high and may be limited by availability in some countries 4.

Safety and Efficacy

• Topical tacrolimus has been shown to be effective and safe for the treatment of moderate to severe atopic dermatitis in pediatric patients 5.
• Topical corticosteroids and topical calcineurin inhibitors have been shown to be effective and safe for the treatment of mild to moderate atopic dermatitis in pediatric patients 4, 5.
• The safety and efficacy of topical treatments for atopic dermatitis in pediatric patients should be carefully considered, taking into account the age and severity of the disease 3, 6, 7.