From the Guidelines
For a child with atopic dermatitis, I strongly recommend using Pimecrolimus (Elidel ointment 1%) or Crisaborole, as they are approved for patients aged 3 months and above in Taiwan, according to the most recent guidelines 1. When managing atopic dermatitis in children, it's essential to consider the severity of the condition and the child's age.
- For mild cases, topical corticosteroids (TCSs) or topical calcineurin inhibitors (TCIs) like Pimecrolimus can be effective.
- For more severe cases, treatment may involve a combination of topical and systemic therapies, including oral antihistamines, wet wrap therapy, or phototherapy, although the latter is not recommended for children under 12 years old 1. Some key considerations when selecting a topical cream include:
- Age and weight of the child
- Severity of the atopic dermatitis
- Presence of any bacterial infections, which may require antibiotic treatment
- Potential for poor treatment adherence or other underlying diagnoses that may impact treatment response. It's crucial to follow a stepwise treatment algorithm, as outlined in the Taiwan guidelines for pediatric atopic dermatitis 1, to ensure the best possible outcomes for the child.
- Adjunct therapies, such as oral antihistamines or psycho-behavioral therapy, can be considered for each phase of treatment.
- Regular follow-up with a healthcare provider is necessary to monitor the child's response to treatment and adjust the therapy as needed.
From the FDA Drug Label
ELIDEL Cream is a prescription medicine used on the skin (topical) to treat eczema (atopic dermatitis). ELIDEL Cream is for adults and children age 2 years and older who do not have a weakened immune system. Do not use ELIDEL Cream on a child under 2 years old. 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 cream for a child with atopic dermatitis (eczema) who is 2 years of age or older is pimecrolimus (ELIDEL) Cream 1% [2] [3].
- It is used for short periods and can be repeated with breaks in between.
- It is not recommended for children under 2 years of age.
From the Research
Topical Creams for Atopic Dermatitis in Children
- Topical corticosteroids are the first-line treatment for atopic dermatitis (AD) flare-ups 4
- Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are second-line treatments for AD 4
- Pimecrolimus cream 1% is approved for mild to moderate atopic dermatitis in children older than two years of age and adults 5
- Tacrolimus ointment 0.03% is approved for moderate to severe atopic dermatitis in children between two to seventeen years of age 5
Efficacy of Tacrolimus and Hydrocortisone
- Tacrolimus ointment (0.03%) has been shown to be an effective and safe non-steroidal topical therapy for the treatment of dermatitis in pediatric patients 6
- A randomized controlled trial found that tacrolimus ointment was more effective than hydrocortisone acetate in reducing the Eczema Area and Severity Index (EASI) score in children with atopic dermatitis 6
- Another study found that tacrolimus reduced inflammatory biomarkers better than hydrocortisone in children with AD 7
Recommended Treatment
- For mild to moderate atopic dermatitis, pimecrolimus cream 1% may be recommended for children older than two years of age 5
- For moderate to severe atopic dermatitis, tacrolimus ointment 0.03% may be recommended for children between two to seventeen years of age 5
- Topical corticosteroids, such as hydrocortisone, may also be used as a first-line treatment for AD flare-ups, but may have more side effects than tacrolimus or pimecrolimus 4, 6, 7