What topical ointments are recommended for pediatric use?

Topical Ointments for Pediatric Use

For minor skin trauma, blisters, and superficial infections in children, mupirocin 2% ointment applied three times daily is the first-line topical antimicrobial recommended by the Infectious Diseases Society of America. 1

First-Line Topical Antimicrobials

• Mupirocin 2% ointment is the preferred topical antimicrobial for preventing secondary bacterial infection in pediatric patients with blisters, minor wounds, and localized staphylococcal skin infections 1, 2
• Apply mupirocin three times daily to affected areas for 7-10 days to prevent secondary bacterial infection 1
• Mupirocin is effective against both Staphylococcus aureus and Streptococcus pyogenes, the two main pathogens in pediatric skin infections 3, 4

Alternative Topical Antimicrobials

• Fusidic acid is an acceptable alternative topical antibiotic for limited impetigo and furunculosis in children 3
• Triple antibiotic ointment (bacitracin, polymyxin B, and neomycin) applied three times daily significantly reduces streptococcal pyoderma development (15% vs 47% with placebo) and is particularly useful for minor skin trauma like mosquito bites and abrasions 5, 6
• Triple antibiotic ointment demonstrates low resistance development and maintains stable susceptibility profiles over time 6

Topical Corticosteroid Ointments

For Atopic Dermatitis (Eczema)

• Low to medium potency topical corticosteroid ointments are preferred first-line options for mild to moderate pediatric atopic dermatitis 7
• Hydrocortisone ointment can be applied to affected areas 3-4 times daily in children 2 years and older 8
• For children under 2 years of age, consult a physician before using hydrocortisone 8
• Tacrolimus ointment 0.03% is approved for children 2 years and older as a steroid-sparing alternative 7
• Pimecrolimus ointment 1% is approved for children 3 months and older 7

For Psoriasis

• Calcipotriol/betamethasone dipropionate ointment applied once daily for up to 4 weeks is recommended for children 12 years and older with mild to moderate plaque psoriasis 7
• This combination provides a corticosteroid-sparing function, which is particularly advantageous for long-term pediatric use 7

For Severe Conditions (Stevens-Johnson Syndrome/TEN)

• Greasy emollients (white soft paraffin ointment or 50/50 white soft paraffin/liquid paraffin) should be applied to urogenital skin and mucosae every 2-4 hours during acute phases 7
• Potent topical corticosteroid ointment (such as clobetasol propionate 0.05%) applied once daily may be considered for involved genital surfaces 7

Antiseptic Adjuncts

• Chlorhexidine antiseptic washes serve as adjunctive therapy to prevent infection in blisters and should be used alongside topical antibiotics in pediatric hidradenitis suppurativa to decrease bacterial resistance 7, 1
• Diluted bleach baths (1 teaspoon per gallon of water for 15 minutes twice weekly) may be considered for children with recurrent skin infections 1

Critical Age-Specific Precautions

Salicylic Acid

• Salicylic acid 6% cream, lotion, gel and 15% plaster are NOT recommended in children under 2 years due to increased risk of salicylate toxicity 7
• In children under 12 years, limit treatment area and monitor for salicylate toxicity signs when using salicylic acid products 7
• Never use salicylates in children with varicella or influenza-like illnesses due to Reye syndrome risk 7

Topical Erythromycin

• Safety and efficacy of single-entity topical erythromycin gel or solution has not been established in children 7
• When used, apply 2% solution, ointment, or gel as a thin film to affected areas once or twice daily 7

Common Pitfalls to Avoid

• Do not use tetracyclines topically or systemically in children under 8 years due to dental staining risk 1, 2
• Leave blisters intact when possible; only pierce large or functionally problematic blisters with sterile technique while preserving the blister roof 1
• Monitor for signs of secondary infection (increasing erythema, warmth, pain, purulent drainage) that would require systemic antibiotics rather than continued topical therapy alone 1
• Avoid prolonged or excessive use of topical corticosteroids due to skin atrophy risk; consider rotational therapy with vitamin D analogues, calcineurin inhibitors, and emollients as steroid-sparing regimens 7