From the Guidelines
Atopic dermatitis in infants requires a comprehensive approach focusing on maintaining skin barrier integrity, avoiding triggers, and controlling inflammation, as recommended by the most recent guidelines 1. The symptoms of atopic dermatitis in infants include dry, itchy, and inflamed skin, which can be managed through gentle skin care practices.
- Daily bathing with lukewarm water and mild, fragrance-free cleansers is essential, followed by the application of a thick moisturizer to lock in moisture.
- Avoiding triggers such as food and inhalant allergens, scratching, environmental irritants, weather conditions, infections, and stress is crucial in managing the condition.
- For mild flares, low-potency topical corticosteroids such as 1% hydrocortisone cream can be used twice daily for 3-7 days, while avoiding medium or high-potency steroids on an infant's delicate skin.
- Keeping the baby's fingernails short and dressing them in soft, cotton clothing can help minimize damage from scratching and reduce irritation.
- Common triggers include harsh soaps, fragrances, dust mites, pet dander, and certain foods if the infant is eating solids, which should be avoided to prevent exacerbating the condition. The treatment options for atopic dermatitis in infants should prioritize gentle and non-invasive approaches, with a focus on maintaining skin barrier integrity and controlling inflammation, as emphasized in the recent Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1.
- Comprehensive education on skin care and trigger avoidance can reduce disease severity and improve quality of life, highlighting the importance of patient education in managing atopic dermatitis.
- While early interventions such as breastfeeding, hydrolyzed formulas, and early introduction of diversified complementary foods may be recommended for high-risk infants, the evidence for their clinical benefits remains equivocal, and therefore, they should be considered on a case-by-case basis 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 The patient or care giver should apply a thin layer of ELIDEL (pimecrolimus) Cream 1% to the affected skin twice daily. The patient or caregiver should stop using when signs and symptoms (e.g., itch, rash and redness) resolve and should be instructed on what actions to take if symptoms recur.
The symptoms of atopic dermatitis in infants include:
- Itch
- Rash
- Redness
- Erythema
- Infiltration/papulation
- Lichenification
- Excoriations
The treatment options for atopic dermatitis in infants include:
- Applying a thin layer of ELIDEL (pimecrolimus) Cream 1% to the affected skin twice daily
- Stopping use when signs and symptoms resolve
- Re-examining the patient if symptoms persist beyond 6 weeks to confirm the diagnosis of atopic dermatitis 2 2
From the Research
Symptoms of Atopic Dermatitis in Infants
- Atopic dermatitis (AD) is a common skin disease during infancy, imposing a considerable burden on patients, their families, and society 3
- Intense itching leads to sleep disturbance, especially in younger children and toddlers 4
- Dry skin conditions during infancy may predict the subsequent development of AD 4
Treatment Options for Atopic Dermatitis in Infants
- Topical standard-of-care for AD in infants includes emollients and topical corticosteroids (TCS) to treat and reduce the risk of flares 3
- Topical calcineurin inhibitors (TCIs), such as pimecrolimus, are recommended for long-term use, treatment of sensitive skin areas, and for use in the pediatric population 3
- Daily use of moisturizers that contain lipids, such as ceramides, reduces the rate of AD flares and the need for topical steroid treatment 5
- Plant-based moisturizers are safe and effective when applied in pediatric patients with AD and may provide a TCS-sparing effect while improving skin condition 4
- The 'wet wrap technique' has been found to be effective in treating children with acute erythrodermic eczema in an inpatient setting 6
Prevention and Maintenance
- Daily use of a moisturizer from birth onwards may offer benefits in improving skin barrier function and possibly prevention of AD, especially in high-risk, atopic prone newborns 4
- Understanding the functional properties of newborn and infant skin, discussing skincare product use with parents, and recommending tailored prescription and skincare routines can improve newborn, infant, and children's skin health 5
- Skin care should be routinely used when counseling patients and caregivers, as its daily use is ongoing and beneficial effects may be lost in less than 1 year after cessation 5