Treatment of Eczema in Infants

First-Line Treatment

The British Medical Journal recommends applying emollients regularly after bathing to provide a surface lipid film that retards evaporative water loss from the epidermis, in infants with eczema 1, 2
The British Medical Journal suggests using a dispersible cream as a soap substitute to cleanse the skin, as soaps and detergents remove natural lipids from the skin surface, in infants with eczema 3, 2
Keeping infant's nails short is recommended to minimize damage from scratching, in infants with eczema 3, 4
Avoiding irritant clothing such as woollens and using cotton clothing instead is recommended, as it is more comfortable for infants with eczema 3

The British Medical Journal recommends using the least potent preparation required to keep eczema under control, in infants with eczema 1
The British Medical Journal suggests stopping corticosteroids for short periods to minimize side effects, when possible, in infants with eczema 1

Sedating antihistamines are useful as a short-term adjuvant to topical treatment during relapses associated with severe pruritus, in infants with eczema 1, 4
Non-sedating antihistamines have little or no value in atopic eczema, according to the British Medical Journal, in infants with eczema 1, 4
Antihistamines should primarily be used at night to help with sleep disruption and avoid daytime sedation, in infants with eczema 2, 4

Antibiotics are important for treating overt secondary bacterial infection, in infants with eczema 1
Flucloxacillin is usually the most appropriate antibiotic for treating Staphylococcus aureus, the commonest pathogen, in infants with eczema 1
For herpes simplex infection (eczema herpeticum), oral acyclovir should be given early in the course of the disease, in infants with eczema 1

Evidence for the role of breastfeeding and maternal avoidance of allergens during pregnancy in protecting against atopy is conflicting, according to the British Medical Journal and the Journal of Microbiology, Immunology and Infection 5, 6
Early interventions such as breastfeeding, hydrolyzed formulas, and early application of skin emollients may be recommended in high-risk infants, though evidence of their clinical benefits remains equivocal, according to the Journal of Microbiology, Immunology and Infection 6

The National Institute of Allergy and Infectious Diseases (NIAID) guidelines state that soy formula shows no significant differences in incidence of infant or childhood atopic dermatitis compared to cow's milk formula, according to the Journal of Allergy and Clinical Immunology 7, 8, 9
Extensively hydrolyzed casein formula (eHF-C) or partially hydrolyzed whey formula (pHF-W) have demonstrated reduced atopic dermatitis incidence in at-risk infants in the GINI study, as reported in the Journal of Allergy and Clinical Immunology 10
The American Academy of Pediatrics recommends exclusive breastfeeding until 4-6 months, which is associated with a lower risk of atopic dermatitis, as shown in the German GINI study 7, 8, 9
Breastfeeding alongside formula supplementation is recommended, as it may delay or prevent the onset of atopic disease, particularly atopic dermatitis, according to the Journal of Allergy and Clinical Immunology 7, 8, 9

The NIAID guidelines recommend against delaying the switch from soy formula, as it provides no protective benefit for atopic dermatitis, according to the Journal of Allergy and Clinical Immunology 7, 8, 9, 11