What are the current management recommendations for pediatric patients with eczema (atopic dermatitis) in the groin area?

From the Guidelines

Management of eczema in the pediatric groin area requires a gentle approach with appropriate medications, prioritizing the use of emollients and low-potency topical corticosteroids to minimize the risk of skin thinning and striae. The most recent and highest quality study 1 emphasizes the importance of educational interventions and prevention of disease flares in the management of atopic dermatitis. Key considerations in managing pediatric eczema in the groin area include:

• Regular use of emollients like petroleum jelly or fragrance-free moisturizers to maintain skin hydration, applied at least twice daily
• Use of low-potency topical corticosteroids such as hydrocortisone 1% or desonide 0.05% for mild to moderate flares, applied in a thin layer once or twice daily after bathing
• Avoidance of medium or high-potency steroids due to the risk of skin thinning and striae
• Consideration of topical calcineurin inhibitors like tacrolimus 0.03% or pimecrolimus 1% as steroid-sparing alternatives for persistent cases
• Trigger avoidance, including the use of fragrance-free detergents, avoidance of harsh soaps, and dressing children in loose-fitting cotton underwear
• Keeping the area clean and dry to prevent secondary infections, with prompt evaluation for antimicrobial therapy if signs of infection develop, as supported by earlier studies 1 and 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

The current management recommendation for pediatric patients with eczema (atopic dermatitis) in the groin area is not explicitly stated in the provided drug label. However, based on the information provided, pimecrolimus cream 1% may be considered for the treatment of mild to moderate atopic dermatitis in pediatric patients aged 2-17 years old.

• The studies support the use of ELIDEL Cream in patients 2 years and older with mild to moderate atopic dermatitis.
• However, the label does not provide specific guidance on the treatment of eczema in the groin area. 2

From the Research

Current Eczema Management Recommendations for Pediatric Patients

Overview of Eczema Management

• Eczema, also known as atopic dermatitis, is a common skin condition that affects pediatric patients, including the groin area 3, 4.
• The management of eczema in pediatric patients involves a combination of topical medications, phototherapy, and systemic medical therapies 4, 5.

Topical Corticosteroids

• Topical corticosteroids are a first-line treatment for eczema, including in pediatric patients 3, 6.
• The potency of topical corticosteroids can vary, and stronger-potency topical corticosteroids are probably more effective than weaker-potency ones in treating moderate or severe eczema 3.
• Applying potent topical corticosteroids once a day probably does not decrease the number of patients achieving treatment success compared to twice daily application 3.

Prevention of Relapse

• Weekend (proactive) therapy with topical corticosteroids probably results in a large decrease in the likelihood of a relapse compared to no topical corticosteroids or reactive application 3.
• This approach can be useful in preventing relapse in pediatric patients with eczema, including in the groin area.

Other Treatment Options

• Topical calcineurin inhibitors, such as pimecrolimus, may be used as an alternative to topical corticosteroids in pediatric patients, including infants as young as 3 months 5.
• Phototherapy may also be used as a treatment option for pediatric patients with eczema, particularly in adolescents over 12 years old 4, 5.
• Systemic medical therapies, such as oral immunosuppressants and biologics, may be used in pediatric patients with severe eczema that does not respond to topical treatments 4, 5.

Safety Considerations

• The long-term safety of topical corticosteroids in pediatric patients with eczema has been evaluated, and intermittent use probably results in little to no difference in risk of growth abnormalities, non-skin infections, and impaired vaccine response 7.
• However, more research is needed to fully understand the safety of long-term topical corticosteroid use in pediatric patients.