Treatment for Moderate to Severe Eczema in Infants

First-Line Treatment

The American Academy of Pediatrics recommends use of mild to moderate potency topical corticosteroids, such as hydrocortisone 1%, for active inflammation in infants with moderate to severe eczema 1, 2
Apply a thin film of topical corticosteroids once or twice daily to affected areas for the shortest period necessary, typically 3-7 days, as recommended by the British Medical Journal 3, 1
Avoid high-potency or ultra-high-potency topical corticosteroids in infants due to their high body surface area-to-volume ratio and increased risk of hypothalamic-pituitary-adrenal (HPA) axis suppression, as advised by the American Academy of Pediatrics 1, 2

Regular use of fragrance-free emollients is recommended to maintain skin barrier integrity in infants with eczema, according to the American Academy of Dermatology 2
Emollients have a steroid-sparing effect and should be used even when the skin appears normal, as suggested by the American Academy of Pediatrics 1, 2

If signs of bacterial infection are present, treat with appropriate antibiotics, such as flucloxacillin for Staphylococcus aureus, as recommended by the British Medical Journal 3
For eczema herpeticum, prompt treatment with oral acyclovir is necessary, according to the American Academy of Pediatrics 3

Proactive treatment with topical corticosteroids twice weekly to previously affected areas can prevent relapses in infants with eczema, as suggested by the American Academy of Dermatology 2
Regular monitoring for signs of skin atrophy, striae, or systemic absorption is recommended, along with careful instruction to caregivers on the amount to apply and safe sites for use, as advised by the American Academy of Pediatrics 1, 2

The risk of adverse effects increases with higher potency, occlusion, and prolonged use of topical corticosteroids, as warned by the American Academy of Pediatrics 1
Avoid long-term application of topical antibiotics due to increased risk of resistance and skin sensitization, as recommended by the American Academy of Dermatology 2
Systemic corticosteroids should be avoided due to risk of rebound flares upon discontinuation, as advised by the American Academy of Pediatrics 2