A 3-month-old infant presents with intensely pruritic, weeping erythematous patches on cheeks and extensor surfaces of arms and legs. Mother has a history of allergic rhinitis. Serum IgE is elevated. Which is the MOST appropriate first-line maintenance therapy to prevent flares?
- A Oral antihistamine (cetirizine) daily
- B Topical tacrolimus 0.03% twice daily
- C Cyclosporine 3 mg/kg/day
- D Regular twice-daily emollient application plus low-potency topical corticosteroid during flares ✓
Explanation
This infant has atopic dermatitis (AD), which presents in infants characteristically on cheeks and extensor surfaces (vs. flexures in older children), is pruritic, and associated with atopic family history and elevated IgE. The cornerstone of maintenance therapy is regular, liberal emollient use (to restore skin barrier) combined with topical corticosteroids during flares — low-potency TCS (e.g., hydrocortisone 1%) for face/body in infants. Emollients reduce flare frequency and severity. Oral antihistamines reduce itch symptomatically but do not treat the underlying skin inflammation and are not disease-modifying. Topical calcineurin inhibitors (tacrolimus 0.03% for ≥2 years; 0.1% for ≥16 years) are second-line agents and not approved under 2 years. Cyclosporine is reserved for severe refractory AD in older children.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.