From the Guidelines
For pediatric atopic dermatitis, low to medium potency topical corticosteroids, such as fluticasone or mometasone, are recommended. These medications should be applied once or twice daily to affected areas during flares, typically until the lesions are significantly improved, as stated in the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1. The choice of topical corticosteroid potency depends on the child's age, affected body area, and severity of inflammation.
- For infants and young children, less potent topical corticosteroids should be used due to the increased risk of adrenal suppression from potent topical corticosteroids 1.
- High potency topical corticosteroids should be used with caution in highly sensitive skin areas, such as the face, neck, and skin folds, to avoid skin atrophy 1.
- Proactive therapy with twice-weekly application of low to medium potency topical corticosteroids to previously affected skin areas for up to 16 weeks may help to prevent relapses in children with moderate to severe atopic dermatitis 1. It's essential to use the appropriate potency based on the child's age, affected body area, and severity of inflammation, and to consider the potential side effects of topical corticosteroids, such as skin atrophy and adrenal suppression 1.
From the FDA Drug Label
ELIDEL ® (pimecrolimus) Cream 1% is indicated as second-line therapy for the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children 2 years of age and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable. The recommended topical corticosteroid is not explicitly mentioned in the provided drug labels for pediatric atopic dermatitis.
- Key points:
- The labels discuss the use of pimecrolimus cream for mild to moderate atopic dermatitis.
- They do not directly recommend a specific topical corticosteroid for pediatric atopic dermatitis 2. The FDA drug label does not answer the question.
From the Research
Topical Corticosteroids for Pediatric Atopic Dermatitis
- Topical corticosteroids (TCS) are currently used as first-line anti-inflammatory treatment for atopic dermatitis (AD) in pediatric patients, due to their overall therapeutic efficacy and availability of different potency classes and formulations 3.
- The choice of topical corticosteroid depends on the severity of the disease, with group 5 TCS being among the most effective for maintaining AD control, followed by tacrolimus and pimecrolimus 4.
- Topical corticosteroids are effective and safe in mild to moderate pediatric AD, with minimal adverse events, although skin atrophy has been reported as an adverse event in TCS trials 5, 6.
Recommendations for Pediatric Atopic Dermatitis
- The American Academy of Dermatology recommends the use of topical corticosteroids as first-line treatment for atopic dermatitis flare-ups, with pimecrolimus and tacrolimus being used in conjunction with topical corticosteroids as first-line treatment 7.
- For moderate to severe AD, topical steroids and calcineurin inhibitors are effective and safe, while systemic monotherapy with dupilumab and JAK inhibitors may be highly effective but are limited by their high cost and availability 5.
- Maintenance therapy for atopic dermatitis consists of liberal use of emollients and daily bathing with soap-free cleansers, with topical corticosteroids being used to treat flare-ups 7.
Safety and Efficacy of Topical Corticosteroids
- The safety of topical medications, including topical corticosteroids, has been evaluated in several studies, with skin atrophy being reported as an adverse event in TCS trials 6.
- Topical corticosteroids have been shown to be effective in improving and maintaining multiple AD outcomes, with group 5 TCS being among the most effective 4.
- The use of topical corticosteroids in pediatric patients is supported by the evidence, with minimal adverse events and high efficacy in treating atopic dermatitis 3, 5, 7, 4.