From the Guidelines
Infant eczema treatment should prioritize gentle skincare, moisturizing, and managing flare-ups, with a focus on maintaining the integrity of the skin barrier and avoiding triggers, as recommended by the most recent guidelines 1. The treatment approach should involve daily bathing using lukewarm water and mild, fragrance-free soap, limiting baths to 5-10 minutes to prevent skin drying.
- Apply a thick moisturizer like petroleum jelly, Eucerin, or Cetaphil immediately after bathing while the skin is still damp.
- For mild flare-ups, use over-the-counter 1% hydrocortisone cream sparingly on affected areas twice daily for up to 7 days.
- More severe cases may require prescription-strength topical steroids like triamcinolone 0.1% or tacrolimus ointment under medical supervision, following a stepwise treatment algorithm 1. It is also essential to dress infants in soft, cotton clothing and keep their nails short to prevent scratching damage.
- Identify and avoid potential triggers such as harsh soaps, certain fabrics, temperature extremes, and possible food allergens, as comprehensive education can reduce disease severity and improve quality of life 1.
- For infants with severe eczema, skin care should be optimized before considering avoidance of suspect allergens from the maternal diet, and if maternal allergen elimination is trialed, a period of reintroduction is necessary to confirm the diagnosis 1. Eczema occurs when the skin barrier is compromised, allowing moisture to escape and irritants to enter, causing inflammation.
- Consistent moisturizing helps repair this barrier, while anti-inflammatory medications reduce the immune response causing the rash. Contact a pediatrician if the eczema worsens, shows signs of infection, or doesn't improve with home treatment.
From the FDA Drug Label
CLINICAL STUDIES Three randomized, double-blind, vehicle-controlled, multi-center, Phase 3 studies were conducted in 589 pediatric patients ages 3 months-17 years old to evaluate ELIDEL ® (pimecrolimus) Cream 1% for the treatment of mild to moderate atopic dermatitis Two of the three trials support the use of ELIDEL Cream in patients 2 years and older with mild to moderate atopic dermatitis ELIDEL Cream is not indicated for use in children less than 2 years of age
The treatment of infant eczema with pimecrolimus cream is not recommended for infants less than 2 years of age, as stated in the drug label 2 and 2.
- Key points:
- Pimecrolimus cream is indicated for patients 2 years and older with mild to moderate atopic dermatitis.
- The drug label does not support the use of pimecrolimus cream in infants less than 2 years of age.
- Two Phase 3 studies were conducted involving infants age 3 months-23 months, but the results do not provide sufficient evidence to support the use of pimecrolimus cream in this age group.
From the Research
Treatment Options for Infant Eczema
- Atopic eczema affects at least 10% of infants at some stage, and nurses play a vital role in supporting patients and families by providing information about the condition and explaining the correct technique for applying topical medication 3.
- Topical corticosteroids (TCS) are the first-line therapy for atopic dermatitis, but they can be associated with significant adverse effects when used chronically, and tacrolimus ointment might be an alternative treatment 4.
Topical Tacrolimus for Atopic Dermatitis
- Tacrolimus 0.1% was better than low-potency TCS, pimecrolimus 1%, and tacrolimus 0.03% in treating atopic dermatitis, and results were equivocal when comparing both dose formulations to moderate-to-potent corticosteroids 4.
- Tacrolimus 0.03% was superior to mild TCS and pimecrolimus 1% in treating atopic dermatitis, and both tacrolimus formulations seemed to be safe, with no evidence found to support the possible increased risk of malignancies or skin atrophy with their use 4.
Network Meta-Analysis of Topical Anti-Inflammatory Treatments
- A network meta-analysis ranked potent and/or very potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% among the most effective treatments for improving patient-reported symptoms and clinician-reported signs in eczema patients 5, 6.
- The analysis also found that local application site reactions were most common with tacrolimus 0.1% and crisaborole 2%, and least common with topical steroids, and skin thinning was not increased with short-term use of any topical steroid potency, but was reported in longer-term use 5, 6.
Comparison of Pimecrolimus and Topical Corticosteroids
- Pimecrolimus is an ascomycin macrolactam derivative with anti-inflammatory and immunomodulatory activity, and it has been approved for the treatment of atopic dermatitis, but corticosteroids remain the treatment of choice in inflammatory skin diseases 7.
- The possibility that pimecrolimus deserves a greater role in the long-term treatment of skin diseases is discussed, and clinical studies that compare pimecrolimus and corticosteroids have been reviewed 7.