How Eczema Treatment Changes From Infancy Through Adulthood

Key Takeaways

• Eczema affects up to about 20 percent of children, a notably higher rate than in adults, and treatment approaches shift meaningfully as a child ages.
• In infants and toddlers, topical corticosteroids and regular moisturizer are the standard first-line approach.
• For moderate to severe eczema not controlled by topicals, the biologic dupilumab is FDA-approved starting at 6 months of age.
• Adults have access to the widest range of systemic treatment options, including several biologics and oral medications, once topical treatment isn't enough.

A condition that looks different at every age

Eczema, also called atopic dermatitis, is a chronic inflammatory skin condition marked by dry, itchy, often reddened skin, and it's remarkably common in childhood, affecting up to about 20 percent of children, a meaningfully higher rate than seen in adults. While the underlying condition doesn't fundamentally change with age, the treatment approach does, shaped by which medications are approved and considered appropriate at different stages of development.

Infants and toddlers

In infants and children under 2, topical corticosteroids remain the standard first-line medication treatment, used alongside consistent, frequent moisturizer application to support the skin barrier. Topical calcineurin inhibitors, such as pimecrolimus, are approved starting at age 2 but are sometimes used off-label as early as 3 months in select cases under a physician's guidance. Regular moisturizer use is considered a core part of maintenance treatment at this age, helping to support the skin barrier and manage the condition, even though evidence that moisturizer alone prevents eczema from developing in at-risk infants has been mixed in research.

Children with moderate to severe disease

When eczema isn't adequately controlled by topical treatment alone, the biologic medication dupilumab is FDA-approved for moderate-to-severe atopic dermatitis starting at 6 months of age, extending systemic treatment options to a much younger population than was available in the past. For children 2 and older, a topical JAK inhibitor medication, ruxolitinib, is also approved for short-term, non-continuous use on limited areas of the body for mild-to-moderate disease, and carries a boxed warning that's worth discussing with your child's physician.

Parents are often surprised at how much has changed even in the last few years, especially how young some of these newer treatments now go. What stays consistent across every age is starting with the basics, moisturizer and gentle skin care, and stepping up treatment only as needed based on how well-controlled the skin actually is, not jumping straight to the newest option available.

— Dr. Robert Tamayev, MD, PhD, Allergy Asthma

Adolescents and adults

By adolescence, patients gain access to a wider range of systemic options, including additional biologic medications and oral JAK inhibitor pills, several of which are approved starting around age 12. Adults have the full range of these systemic treatment options available to them for moderate-to-severe disease that isn't controlled by topical treatment, giving physicians more flexibility to match a specific medication to a patient's disease pattern, other health conditions, and personal preference. Across every age group, though, these systemic options are generally reserved for moderate-to-severe eczema that hasn't responded adequately to topical treatment, rather than being used as a first-line approach.

When to book a visit

If your child's eczema, or your own, isn't well controlled by moisturizer and topical treatment, or symptoms are significantly affecting sleep, daily comfort, or quality of life, it's worth scheduling an evaluation to discuss whether it's time to consider additional treatment options appropriate for your age and severity.

Disclaimer: This content is educational and does not substitute for medical advice. Always consult your physician for personal medical questions.