From the Guidelines
Atopic dermatitis in babies is best managed through gentle skincare and targeted treatments, with a focus on optimizing skin care before considering allergen avoidance from the maternal diet, as recommended by the most recent guidelines 1. When managing atopic dermatitis in babies, it is essential to start with daily lukewarm baths (5-10 minutes) using mild, fragrance-free soap, followed immediately by applying a thick moisturizer like petroleum jelly, Eucerin, or CeraVe while the skin is still damp to lock in moisture. For mild flares, use over-the-counter 1% hydrocortisone cream on affected areas twice daily for up to 7 days. For moderate to severe cases, a pediatrician may prescribe stronger topical steroids like triamcinolone 0.1% or stronger medications like tacrolimus (Protopic) or pimecrolimus (Elidel) for sensitive areas like the face. Some key considerations include:
- Dressing babies in soft, cotton clothing
- Keeping fingernails short to prevent scratching
- Identifying and avoiding triggers such as harsh soaps, certain fabrics, dust mites, pet dander, or food allergens According to recent studies, if maternal allergen elimination is trialed to manage severe infantile eczema, it is imperative that a period of reintroduction is used to re-elicit symptoms and confirm the diagnosis before longer periods of dietary restriction 1. Additionally, for breast-fed infants suspected to have a non–IgE-mediated milk allergy, a trial of a maternal cow’s milk–free diet is recommended for a 1- to 2-week period, followed by rechallenge to assess whether symptom re-elicitation occurs 1. The Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis provide a concise overview of its epidemiology, clinical characteristics, and diagnosis, as well as treatment options and education 1. Overall, the management of atopic dermatitis in babies requires a comprehensive approach that incorporates gentle skincare, targeted treatments, and avoidance of triggers, with a focus on optimizing skin care and confirming diagnoses through reintroduction and rechallenge.
From the FDA Drug Label
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. ELIDEL Cream is not indicated for use in children less than 2 years of age
The treatment of atopic dermatitis in babies is not recommended with pimecrolimus (TOP) cream 1% for children less than 2 years of age 2.
From the Research
Atopic Dermatitis in Babies
- Atopic dermatitis (AD) typically starts in infancy and early childhood, and is associated with recurrent flares, pruritus, and genetic predisposition 3.
- The daily use of moisturizers that contain lipids, such as ceramides, reduces the rate of AD flares and the need for topical steroid treatment 3.
- Studies on the prophylactic application of moisturizers initiated in early infancy suggest moisturizers may delay rather than prevent AD, especially in high-risk populations and when used continuously 3.
Treatment and Management
- Maintenance therapy for atopic dermatitis consists of liberal use of emollients and daily bathing with soap-free cleansers 4.
- Topical corticosteroids are the first-line treatment for atopic dermatitis flare-ups, while pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment 4, 5, 6.
- Pimecrolimus has similar anti-inflammatory effects to low-to-medium strength topical corticosteroids, reduces pruritus, and improves the quality of life of patients, without causing skin atrophy 6.
Prevention
- The preventive effect of moisturizers on atopic dermatitis is still unclear, and may depend on skin care methods and study design 7.
- A combination of minimally invasive cleaning methods and moisturizing may prevent AD in infants, especially in dry and cold seasons 7.
- Appropriate skin care practices for newborns and infants may vary in regions and environments, and should be tailored to individual needs 7.