A 6-month-old infant develops intensely pruritic erythematous papulovesicular lesions on the cheeks and extensor surfaces. The mother has a history of asthma. Serum IgE is elevated. What is the first-line topical maintenance therapy for moderate atopic dermatitis (AD) in this age group?

• A Tacrolimus ointment 0.1%
• B Betamethasone valerate 0.1% cream
• C Oral antihistamines (cetirizine) as primary therapy
• D Topical hydrocortisone 1% with regular moisturizer ✓

Explanation

In infants under 2 years with moderate atopic dermatitis, the first-line topical anti-inflammatory is low-potency corticosteroid such as hydrocortisone 1% cream applied to affected areas, combined with liberal use of emollients/moisturisers as the cornerstone of therapy. High-potency steroids (betamethasone) are avoided in infants due to risk of skin atrophy and systemic absorption. Tacrolimus 0.1% is approved for patients ≥15 years; tacrolimus 0.03% is approved for ≥2 years. Oral antihistamines do not significantly reduce eczema but may help with sleep disruption. Proactive therapy (intermittent steroids on previously affected skin) reduces flares.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.