What is the management of atopic dermatitis (eczema) in infants?

From the Guidelines

To manage eczema in a baby, it is crucial to focus on gentle skincare, identifying triggers, and optimizing skin care before considering any dietary restrictions, as emphasized by the most recent study 1. When managing eczema in babies, several key strategies can help alleviate symptoms and improve quality of life.

• Use lukewarm baths (5-10 minutes) with mild, fragrance-free soap, followed by immediate application of a thick moisturizer like petroleum jelly, Eucerin, CeraVe, or Aquaphor while skin is still damp, as this helps to lock in moisture and repair the skin barrier.
• Moisturize at least twice daily to maintain the integrity of the skin and prevent dryness, which can exacerbate eczema symptoms.
• Dress your baby in soft, cotton clothing and keep fingernails short to prevent scratching damage, which can lead to infection and further complications.
• Identify and avoid triggers such as harsh soaps, certain fabrics, dust mites, pet dander, or food allergies, as these can provoke eczema flares. For mild flares, using over-the-counter 1% hydrocortisone cream sparingly on affected areas for up to 7 days can be beneficial, but it's essential to consult a pediatrician for guidance on the best treatment approach. In cases of severe eczema, optimizing skin care is the first step, and if maternal allergen elimination is considered, it should be done under professional supervision with a clear plan for reintroduction to confirm the diagnosis, as recommended by 1. It's also important to note that while older studies like 1 and 1 provide valuable insights into the management of atopic eczema, the most recent and highest quality evidence should guide clinical decision-making, prioritizing the well-being and safety of the baby.

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 Pediatric Use ELIDEL Cream is not indicated for use in children less than 2 years of age

For babies with eczema, pimecrolimus cream 1% is not indicated for use in children less than 2 years of age 2. For babies over 2 years, pimecrolimus cream 1% can be used to treat mild to moderate atopic dermatitis, as supported by two of the three clinical trials 2. Key considerations for managing eczema in babies include:

• Age restriction: pimecrolimus cream 1% is not indicated for children less than 2 years old
• Treatment efficacy: pimecrolimus cream 1% has been shown to be effective in treating mild to moderate atopic dermatitis in pediatric patients 2 years and older 2
• Safety profile: common adverse events in pediatric patients include application site burning, headache, and nasopharyngitis 2

From the Research

Managing Eczema in Babies

To manage eczema in babies, several strategies can be employed, including the use of topical corticosteroids, topical anti-inflammatory treatments, and maintaining good skin care habits.

• Topical Corticosteroids: The use of topical corticosteroids is a common approach for managing eczema in babies 3. Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema.
• Application Frequency: Applying potent topical corticosteroids once a day probably does not decrease the number achieving treatment success compared to twice daily application 3.
• Proactive Therapy: Weekend (proactive) therapy with topical corticosteroids probably results in a large decrease in likelihood of a relapse from 58% to 25% 3.
• Topical Anti-Inflammatory Treatments: Network meta-analysis has shown that potent and/or very potent topical steroids, tacrolimus 0.1%, and ruxolitinib 1.5% are among the most effective treatments for improving patient-reported symptoms and clinician-reported signs 4.
• Skin Care: Maintaining good skin care habits, such as keeping the skin moisturized and avoiding irritants, is also important for managing eczema in babies.
• Treatment Options: Other treatment options, such as pimecrolimus, delgocitinib, and crisaborole, may also be effective in managing eczema in babies, but the evidence is not as strong 5.
• Potential Side Effects: Local adverse events, such as abnormal skin thinning, can occur with the use of topical corticosteroids, but the frequency is low overall and increases with increasing potency 3, 4.