From the Guidelines
For a 6-month-old with an initial presentation of eczema, I recommend starting with a low-potency topical steroid such as 1% hydrocortisone cream, as it is essential to use the least potent preparation required to keep the eczema under control, and when possible, the corticosteroids should be stopped for short periods 1. This approach is crucial in minimizing potential side effects associated with topical steroid use, especially in infants with thinner skin that absorbs medications more readily than adult skin. Key considerations include:
- Applying a thin layer to affected areas twice daily for 7-10 days
- Using the minimum amount necessary to avoid excessive absorption
- Avoiding application on the face, genitals, or in skin folds where absorption is increased
- Implementing a comprehensive skin care routine that includes daily bathing with lukewarm water followed by immediate application of a fragrance-free moisturizer to damp skin
- Monitoring response to treatment and considering referral to a pediatric dermatologist if the eczema doesn't respond within 1-2 weeks. It is also vital to educate parents about the benefits and risks of topical corticosteroids and the importance of adherence to the recommended treatment plan, as lack of adherence may often be traced back to patients' or parents' fears of steroids 1.
From the FDA Drug Label
Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced HPA axis suppression and Cushing's syndrome than mature patients because of a larger skin surface area to body weight ratio Administration of topical corticosteroids to children should be limited to the least amount compatible with an effective therapeutic regimen.
For a 6-month-old patient with an initial presentation of eczema, hydrocortisone (TOP) may be a suitable option due to its lower potency compared to other topical steroids like triamcinolone (TOP).
- The choice of topical steroid should be based on the least amount compatible with an effective therapeutic regimen to minimize the risk of systemic toxicity and HPA axis suppression.
- It is essential to monitor the patient's response to treatment and adjust the topical steroid as needed to avoid potential adverse effects 2.
From the Research
Topical Steroid Options for Eczema in Infants
- For a 6-month-old infant with an initial presentation of eczema, the choice of topical steroid depends on the severity of the eczema and the potential risks of treatment.
- According to the study 3, potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema.
Considerations for Infant Treatment
- When treating infants, it is essential to consider the potential risks of topical corticosteroids, including local adverse events such as abnormal skin thinning.
- The study 3 found that the frequency of abnormal skin thinning was low overall but increased with increasing potency of the topical corticosteroid.
Recommended Treatment Approach
- Based on the available evidence 3, a moderate-potency topical corticosteroid may be a suitable option for a 6-month-old infant with moderate or severe eczema.
- However, it is crucial to carefully evaluate the individual patient's needs and monitor for potential adverse events.
- The study 3 also suggests that applying potent topical corticosteroids only once a day probably does not decrease the number achieving treatment success compared to twice daily application.