From the Guidelines
Atopic dermatitis in babies should be managed with a comprehensive approach that includes education, maintaining the integrity of the skin barrier, and avoiding triggers, as this can reduce disease severity and improve quality of life. According to the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis 1, comprehensive education is key to managing the condition. This education should focus on maintaining the skin barrier through the use of emollients and bathing, as well as avoiding triggers such as food and inhalant allergens, scratching, environmental irritants, weather conditions, infections, and stress.
Key Management Strategies
- Daily lukewarm baths lasting 5-10 minutes using mild, fragrance-free soap
- Immediate application of a thick moisturizer like petroleum jelly, Eucerin, or Cetaphil while the skin is still damp
- Applying moisturizer multiple times daily, especially after bathing
- Using low-potency topical corticosteroids like hydrocortisone 1% cream twice daily for 3-7 days for mild flares
- Dressing babies in soft, cotton clothing and keeping nails short to prevent scratching damage
- Identifying and avoiding triggers such as harsh soaps, certain fabrics, temperature extremes, and potential food allergens
Prevention and Early Intervention
Early interventions for prevention of atopic dermatitis, such as breastfeeding, hydrolyzed formulas, early introduction of diversified complementary foods, and early application of skin emollients, may be recommended in high-risk infants, albeit evidence of their clinical benefits and impact on disease severity remains equivocal 1. Complementary therapy such as probiotics and vitamin D has yet to demonstrate convincing benefits for atopic dermatitis.
Monitoring and Follow-up
It is essential to monitor the baby's condition and seek medical attention if the rash becomes infected, if prescribed treatments are not effective, or if the baby appears uncomfortable or has trouble sleeping due to itching. By following these management strategies and seeking medical attention when necessary, parents and caregivers can help reduce the severity of atopic dermatitis and improve the quality of life for babies with this condition.
From the FDA Drug Label
ELIDEL Cream is not indicated for use in children less than 2 years of age The long-term safety and effects of ELIDEL Cream on the developing immune system are unknown Two Phase 3 studies were conducted involving 436 infants age 3 months-23 months In the 6-week study, 11% of ELIDEL and 48% of vehicle patients did not complete this study; no patient in either group discontinued due to adverse events. Infants on ELIDEL Cream had an increased incidence of some adverse events compared to vehicle
For babies with atopic dermatitis, pimecrolimus cream is not indicated for use in children less than 2 years of age.
- For infants aged 3 months to 23 months, pimecrolimus cream may be used, but with caution, as it has been associated with an increased incidence of adverse events such as pyrexia, URI, and nasopharyngitis.
- Close monitoring is recommended when using pimecrolimus cream in infants. 2 2
From the Research
Management of Atopic Dermatitis in Babies
Atopic dermatitis is a chronic, relapsing skin disease that typically starts in atopic-prone children between 3–6 months of age 3. The management of atopic dermatitis in babies involves controlling skin barrier function and inflammation using a moisturizer and proactive treatment.
- Moisturizer Therapy: Daily use of a moisturizer from birth onwards may offer benefits in improving skin barrier function and possibly preventing atopic dermatitis, especially in high-risk, atopic-prone newborns 3.
- Topical Therapy: Topical agents, including emollients, topical corticosteroids, topical calcineurin inhibitors, and phosphodiesterase 4 inhibitors, are used to manage infantile atopic dermatitis 4.
- Parental Education: Parental education and the application of moisturizers are recommended as an integral part of atopic dermatitis prevention, treatment, and maintenance 3.
- Treatment Guidelines: Recent treatment guidelines are written primarily for use by specialists, but primary care providers can use a streamlined severity-based treatment model to manage a majority of atopic dermatitis cases 5.
- Nonpharmacologic Interventions: Nonpharmacologic interventions, such as avoiding common triggers and educating patients/caregivers, are important in managing atopic dermatitis in pediatric patients 6.
Treatment Options
- Topical Corticosteroids: Use of topical corticosteroids is the first-line treatment for atopic dermatitis flare-ups 7.
- Topical Calcineurin Inhibitors: Pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment 7.
- Ultraviolet Phototherapy: Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 7.
- Newer Medications: Newer medications, such as crisaborole and dupilumab, are effective in treating atopic dermatitis but are currently cost-prohibitive for most patients 7.