Is mometasone (mometasone furoate) suitable for treating infant eczema?

Mometasone Furoate for Infant Eczema

Mometasone furoate is not recommended for infants with eczema due to safety concerns and lack of FDA approval for children under 12 years of age. 1

Safety Concerns in Infants

Mometasone furoate poses several significant risks when used in infants:

• HPA axis suppression risk: The FDA label explicitly states that mometasone furoate caused hypothalamic-pituitary-adrenal (HPA) axis suppression in approximately 29% of pediatric patients ages 6 to 23 months who were treated for approximately 3 weeks 1
• Higher absorption risk: Infants have a higher ratio of skin surface area to body mass, putting them at greater risk of systemic absorption and associated complications 1
• FDA approval status: Mometasone furoate is not approved for use in children under 12 years of age 1
• Potential complications: Systemic absorption in pediatric patients can lead to Cushing's syndrome, linear growth retardation, delayed weight gain, and intracranial hypertension 1

Appropriate Alternatives for Infant Eczema

For infants with eczema, the following approach is recommended:

1. First-line therapy: Low-potency topical corticosteroids (e.g., hydrocortisone 1%) are more appropriate for infants with eczema 2

   • Apply twice daily for short courses (typically 3-5 days)
   • Avoid application to the face, diaper area, and skin folds unless specifically directed

2. Adjunctive treatments:

   • Regular use of emollients to maintain skin barrier function 3
   • Calamine lotion may be used as an adjunctive therapy to enhance effectiveness 4
   • Tacrolimus 0.1% ointment may be considered for facial and genital regions in cases where topical steroids are contraindicated 3

3. Treatment duration and monitoring:

   • Limit treatment courses to short periods
   • Monitor for signs of skin atrophy, striae, or systemic absorption
   • Follow up regularly to assess response and potential adverse effects

Common Pitfalls to Avoid

• Inappropriate potency selection: Using medium or high-potency steroids like mometasone in infants increases risk of side effects 2
• Prolonged use: Extended treatment increases risk of systemic absorption and local side effects 1
• Occlusive dressings: Avoid using occlusive dressings or applying in the diaper area, as this increases absorption 1
• Parental steroid phobia: Inadequate education about proper use of topical steroids can lead to undertreatment due to excessive concerns 5

Evidence Quality and Considerations

The recommendation against using mometasone in infants is based primarily on the FDA drug label 1, which provides clear warnings about use in children under 12 years. While some research has examined mometasone in older children 6, 7, these studies did not include infants and cannot be extrapolated to this vulnerable population.

The American Academy of Dermatology guidelines support the use of topical calcineurin inhibitors for facial and genital psoriasis in pediatric patients 3, which may be applicable to eczema in sensitive areas, but these should be used cautiously and only when appropriate.

For infant eczema, low-potency topical corticosteroids remain the safest and most appropriate treatment option when used judiciously and for limited periods.