and maintenance treatment, and clinical pearls. The advisors felt the case studies presented during the meeting and the six selected cases presented in the paper were a comprehensive collection of typical presentations covering the necessary teaching points.
Patient 1: This 4-month-old boy with Fitzpatrick phototype III has had eczema since he was one month old (Table 1). He had neonatal acne, seborrhea, and bronchiolitis at three months old. AD was present all over his face, trunk, and extremities from one month of age. The infant's condition caused maternal anxiety. Previously, no skincare or medical treatment was used. At week 2, CER-containing baby wash, shampoo, and 1% hydrocortisone cream were started. At week 4, a CER-containing moisturizing cream was added to the regime, and at week 12, crisaborole twice daily was added. Over the 12-week observation period, the infants' skin condition had markedly improved.
The main lessons learned: A newborn with persistent erythema and xerosis may develop AD flares early on.3 Therefore, it is crucial to start educating parents about the importance of maintaining a healthy skin barrier as early as the prenatal or first newborn visit.4-8
Patient 2: This 2-month-old boy with Fitzpatrick phototype IV presented with deep dark red oozing lesions covering his face and abdomen, which started immediately after birth (Table 3). A baby petrolatum-containing ointment was recommended but not consistently used. The lesions were previously treated with mupirocin ointment and oral cephalexin for presumed secondary bacterial infection. His skin condition first improved and then deteriorated, and cultures at one time grew methicillin-resistant Staphylococcus aureus (MRSA). The parents consulted a dermatologist who addressed the presumed infection and recommended continuing mupirocin. A different culture was done five days before the visit to our clinic, which showed Enterococcus faecalis and Escherichia coli. The parents were educated about their infant's skin condition and the situations and products that may trigger skin breakouts. The role of CER-containing skincare in AD treatment and maintenance was discussed with the parents. Treatment started with a CER-containing baby moisturizing wash, twice daily liberal use of CER-containing healing ointment, and once daily application of a fluocinolone-containing oil, a very low potency topical steroid. The evolution of the infant's skin condition was closely followed by phone. After using the CER-containing healing ointment and once daily application of a fluocinolone-containing oil for five days, his facial and abdominal skin condition improved markedly. At the week 6 visit, the healing ointment was replaced with a CER-containing baby lotion three times daily, which, together with the CER-containing baby moisturizing wash, is continued ongoing.
The main lessons learned: Educating parents about maintaining a healthy skin barrier as early as the prenatal or first newborn visit is important. Secondary infection may result from impaired skin barrier function and dysbiosis related to AD.10,11 Consistent use of CER-containing skincare from birth can markedly improve AD in infants.7,8
