Treatment of Atopic Dermatitis in Infants

Basic Therapy (First-Line)

The American Academy of Pediatrics recommends applying fragrance-free emollients regularly to maintain skin barrier integrity, which is essential for all infants with atopic dermatitis regardless of disease severity 1, 2
Infants with atopic dermatitis should use lukewarm water (10-15 minutes) with gentle, soap-free cleansers, followed immediately by application of emollients to lock in moisture 1, 3
Identifying and eliminating potential triggers such as irritants, allergens, excessive sweating, changes in temperature or humidity, and stress is crucial for managing atopic dermatitis in infants 1, 2
Comprehensive education to parents about proper skin care routine and the chronic, relapsing nature of atopic dermatitis is essential for effective management 4

The American Academy of Dermatology recommends using low-potency topical corticosteroids (such as 1% hydrocortisone) for flares in infants 1, 2
Low-potency topical corticosteroids should be applied a thin layer to affected areas only, not as a general moisturizer, and limit duration of exposure to potent topical corticosteroids in sensitive skin areas (face, neck, skin folds) to avoid skin atrophy 1, 2
Infants should be treated with less potent topical corticosteroids than adults due to increased risk of adrenal suppression 3
Proactive therapy with twice-weekly application of low-potency topical corticosteroids to previously affected areas may help prevent relapses in moderate to severe cases 4

Topical calcineurin inhibitors (such as pimecrolimus and tacrolimus) are not approved for infants under 2 years old 1
Topical PDE-4 inhibitors (such as crisaborole) have been approved for patients aged 3 months and above for mild to moderate atopic dermatitis 5
Long-term application of topical antibiotics is not recommended due to increased risk of resistance and skin sensitization, and should only be considered when there is clinical evidence of bacterial infection 1, 4
Oral antihistamines may be used as adjuvant therapy for reducing pruritus, primarily for their sedative properties to help with sleep disturbance during severe flares 2, 4

For mild atopic dermatitis, basic therapy with emollients and trigger avoidance, and reactive therapy with low-potency topical corticosteroids during flares is recommended 4
For moderate atopic dermatitis, basic therapy with emollients and trigger avoidance, proactive and reactive therapy with low-potency topical corticosteroids, and consideration of topical PDE-4 inhibitor (crisaborole) as an alternative is recommended 4, 5
For severe atopic dermatitis, basic therapy with emollients and trigger avoidance, proactive and reactive therapy with low to medium potency topical corticosteroids, and consideration of wet-wrap therapy for short periods is recommended 1, 3, 4

If the condition worsens despite appropriate first-line management, referral to a specialist should be considered 2
If there are signs of suspected secondary infection not responding to treatment, referral to a specialist should be considered 2
For consideration of more advanced therapies in severe cases, referral to a specialist is recommended 4