First-Line Treatment for Eczema in Infants

Emollient Therapy

The American Academy of Dermatology recommends applying emollients liberally and frequently to maintain skin hydration and improve barrier function in infants with eczema 1
Emollients are most effective when applied immediately after bathing to prevent dryness and improve skin health 1
Replace regular soaps with soap substitutes (dispersable creams) to prevent removal of natural skin lipids and reduce irritation 1

The British Medical Association recommends using mild-potency topical corticosteroids (1% hydrocortisone) for flare-ups in infants with eczema 2, 1
Use the least potent preparation required to keep the eczema under control, as recommended by the British Medical Association 2
Apply topical corticosteroids for limited periods until the flare resolves, as advised by the American Academy of Dermatology 1

Infants are particularly susceptible to side effects from topical corticosteroids due to their high body surface area to volume ratio, according to the Journal of the American Academy of Dermatology 3

The British Medical Association suggests that antihistamines may be useful as a short-term adjuvant during severe flares with significant itching in infants with eczema 2
The therapeutic value of antihistamines is primarily due to their sedative properties, as noted by the British Medical Association 2
Non-sedating antihistamines have little to no value in atopic eczema, according to the British Medical Association and the American Academy of Dermatology 2, 1

Monitor for signs of secondary bacterial infection (crusting, weeping, punched-out erosions) in infants with eczema, as recommended by the American Academy of Dermatology 1
Flucloxacillin is usually the most appropriate antibiotic for treating Staphylococcus aureus, the most common pathogen, according to the British Medical Association 2
Viral infections, particularly herpes simplex (eczema herpeticum), require prompt treatment with acyclovir, as advised by the British Medical Association 2

Failure to respond to first-line treatment is an indication for specialist referral, according to the British Medical Association 4
Diagnostic uncertainty is an indication for specialist referral, as recommended by the American Academy of Dermatology 1
When second-line treatments are being considered, specialist referral is indicated, according to the British Medical Association 4
When specialist opinion would be valuable for management, referral is indicated, as advised by the American Academy of Dermatology 1

The American Academy of Dermatology recommends transitioning to proactive maintenance therapy after flare resolution, rather than waiting for the next flare, to reduce relapse risk from 58% to 25% (RR 0.43) compared to reactive treatment only 5
The American Academy of Dermatology suggests applying topical corticosteroids or topical calcineurin inhibitors twice weekly to previously affected areas even when skin appears clear, and continuing daily emollient use to all areas 5

The American Academy of Dermatology advises that proactive twice-weekly therapy reduces relapse risk compared to reactive treatment only, based on evidence that clinically normal-appearing skin in eczema patients has persistent subclinical inflammation and barrier defects 5
The guideline recommends applying topical corticosteroids only until flare resolves, then transitioning to maintenance strategy, and not using topical corticosteroids continuously without breaks 5