What is the first-line treatment for eczema in a 7-month-old?

First-Line Treatment for Eczema in a 7-Month-Old

The first-line treatment for eczema in a 7-month-old consists of liberal application of emollients for daily maintenance and mild-potency topical corticosteroids (such as 1% hydrocortisone) for flare-ups. 1, 2

Emollient Therapy

• Apply emollients liberally and frequently to maintain skin hydration and improve barrier function 1
• Emollients are most effective when applied immediately after bathing 1
• Use emollients as the preventive background therapy in all stages of eczema 3
• Replace regular soaps with soap substitutes (dispersable creams) to prevent removal of natural skin lipids 1

Topical Corticosteroid Therapy

• Use mild-potency topical corticosteroids (1% hydrocortisone) for flare-ups 2, 1
• Apply topical corticosteroids to affected areas no more than 3-4 times daily 4
• For children under 2 years of age, consult with a doctor before application 4
• Use the least potent preparation required to keep the eczema under control 2
• Apply for limited periods until the flare resolves 1
• Once-daily application of topical corticosteroids is likely as effective as twice-daily application 5

Special Considerations for Infants

• Infants are particularly susceptible to side effects from topical corticosteroids due to their high body surface area to volume ratio 2
• Avoid potent and very potent topical corticosteroids in infants 6
• Monitor closely for potential side effects, though abnormal skin thinning is rare (reported in only 1% of cases in clinical trials) 5

Managing Pruritus

• Antihistamines may be useful as a short-term adjuvant during severe flares with significant itching 2
• The therapeutic value of antihistamines is primarily due to their sedative properties 2
• Non-sedating antihistamines have little to no value in atopic eczema 2, 1

Addressing Secondary Complications

• Monitor for signs of secondary bacterial infection (crusting, weeping, punched-out erosions) 1
• Flucloxacillin is usually the most appropriate antibiotic for treating Staphylococcus aureus, the most common pathogen 2
• Viral infections, particularly herpes simplex (eczema herpeticum), require prompt treatment with acyclovir 2

Additional Supportive Measures

• Emollients alone can be effective in decreasing symptoms and reducing the need for steroids 7
• The order of application between emollients and topical corticosteroids does not significantly affect treatment outcomes; parents can apply in whichever order they prefer 8
• Wet wrap dressings may be effective for severe cases but increase the risk of skin infections 7

Indications for Specialist Referral

• Failure to respond to first-line treatment 2
• Diagnostic uncertainty 1
• When second-line treatments are being considered 2
• When specialist opinion would be valuable for management 1