What is the treatment for atopic dermatitis in a 1-year-old?

Treatment of Atopic Dermatitis in a 1-Year-Old

The cornerstone of treatment for atopic dermatitis in a 1-year-old is regular application of emollients, gentle bathing practices, and low-potency topical corticosteroids for flares, while avoiding potential triggers. 1, 2

Basic Therapy (First-Line)

• Emollients: Apply fragrance-free emollients regularly to maintain skin barrier integrity, which is essential for all infants with atopic dermatitis regardless of disease severity 1, 2
• Bathing: Use lukewarm water (10-15 minutes) with gentle, soap-free cleansers, followed immediately by application of emollients to lock in moisture 1, 2
• Trigger avoidance: Identify and eliminate potential triggers such as irritants, allergens, excessive sweating, changes in temperature or humidity, and stress 1, 2
• Education: Provide comprehensive education to parents about proper skin care routine and the chronic, relapsing nature of atopic dermatitis 1

Topical Anti-inflammatory Treatment (For Flares)

• Topical corticosteroids (TCS): Use low-potency TCS (such as 1% hydrocortisone) for flares in 1-year-olds 1, 2

  • Apply a thin layer to affected areas only, not as a general moisturizer
  • Limit duration of exposure to potent TCS in sensitive skin areas (face, neck, skin folds) to avoid skin atrophy
  • Children should be treated with less potent TCS than adults due to increased risk of adrenal suppression 1

• Proactive therapy: For moderate to severe cases, twice-weekly application of low-potency TCS to previously affected areas may help prevent relapses 1

• Wet-wrap therapy: Consider as a short-term (3-7 days) second-line treatment for moderate to severe atopic dermatitis that doesn't respond to conventional topical therapy 1

Important Considerations and Precautions

• Topical calcineurin inhibitors (TCIs): Pimecrolimus and tacrolimus are approved for children 2 years and older, not for 1-year-olds 1, 3

• Topical PDE-4 inhibitors: Crisaborole has been approved for patients aged 3 months and above for mild to moderate atopic dermatitis 1

• Antibiotics: Long-term application of topical antibiotics is not recommended due to increased risk of resistance and skin sensitization 1

  • Consider antibiotics only when there is clinical evidence of bacterial infection 1

• Antihistamines: Oral antihistamines may be used as adjuvant therapy for reducing pruritus, primarily for their sedative properties to help with sleep disturbance during severe flares 1, 2

• Topical antihistamines: Not recommended as evidence for efficacy is insufficient and they may increase risk of contact dermatitis 1

Stepwise Treatment Approach

For Mild Atopic Dermatitis:

• Basic therapy with emollients and trigger avoidance 1
• Reactive therapy with low-potency TCS during flares 1

For Moderate Atopic Dermatitis:

• Basic therapy with emollients and trigger avoidance 1
• Proactive and reactive therapy with low-potency TCS 1
• Consider topical PDE-4 inhibitor (crisaborole) as an alternative 1

For Severe Atopic Dermatitis:

• Basic therapy with emollients and trigger avoidance 1
• Proactive and reactive therapy with low to medium potency TCS 1
• Consider wet-wrap therapy for short periods 1
• Consider referral to a specialist if condition worsens despite appropriate management 2

When to Consider Referral

• If the condition worsens despite appropriate first-line management 2
• If there are signs of suspected secondary infection not responding to treatment 2
• For consideration of more advanced therapies in severe cases 1

Remember that atopic dermatitis typically follows a relapsing course, with approximately 80% of patients developing symptoms within the first 5 years of life 1. Regular use of emollients has both short-term and long-term steroid-sparing effects in mild to moderate atopic dermatitis 1, 4.