Atopic dermatitis in infants: Options and considerations for treatment and prevention

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Atopic dermatitis (AD) affects 10% to 20% of children and develops by age 1 in about 60% of affected individuals. In infants, inadequately controlled AD is associated with a poorer prognosis and persistent disease, and may predispose them to future development of atopic disease conditions. Non-pharmacologic treatment of AD includes avoidance and elimination of triggers as well as emollient therapy. Topical corticosteroids (TCSs) have been a cornerstone of AD treatment for several decades, but concerns persist over the potential for local and systemic adverse effects, particularly in infants. Infants may be more susceptible than older patients to systemic absorption of topical medications due to a greater body surface area to weight ratio, immaturity of the skin barrier, and a tendency for AD symptoms to manifest in areas of the skin that are thinner (eg, face, neck). Topical calcineurin inhibitors (TCIs) are newer agents that can provide effective treatment of AD without the local and systemic side effects associated with most TCSs. However, TCIs are currently indicated only for children 2 years of age and older. The accumulating data supports the long-term efficacy (2 years or longer) and safety of the TCI pimecrolimus in infants with AD. Although prospective data are lacking, tacrolimus has been shown to improve symptoms of AD in retrospective chart reviews. Preliminary results for a peroxisome proliferator-activated receptor alpha agonist in infants with AD appear promising as well. Probiotic therapy and breastfeeding may reduce the risk of the development of AD, but findings are inconsistent.

Original languageEnglish (US)
Pages (from-to)190-202
Number of pages13
JournalInternational Pediatrics
Issue number4
StatePublished - Dec 1 2008

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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