Steroid Stewardship during Infant Flare

In managing this severe atopic dermatitis flare in an 18-month-old infant, experts highlight key diagnostic and educational steps. Dr. Eichenfield first assesses morphology for signs of impetiginized eczema or a post-viral flare, common triggers requiring antibiotic treatment or anti-inflammatory escalation. With 15% BSA and potential nummular plaques, a short course of mid- to high-potency topical corticosteroids may be necessary for rapid control, followed by a transition to a non-steroidal agent like roflumilast for long-term management. Dr. Golant addresses steroid stewardship, warning against dangerous practices like mixing steroids into moisturizers. She emphasizes that recurrent infection signals inadequately controlled disease and stresses educating parents on appropriate steroid use, systemic risks in young children, and the critical long-term planning needed to alter the disease trajectory and prevent future flares.