A 4-month-old infant has a history of reddened, dry, itchy skin. The primary care pediatric nurse practitioner notes fine papules on the extensor aspect of the infant's arms, anterior thighs, and lateral aspects of the cheeks. What is the initial treatment?

• A. Moisturizers
• B. Oral antihistamines
• C. Topical corticosteroids
• D. Wet wrap therapy

Answer: (A)

This presentation is classic for infantile atopic dermatitis, where the skin barrier is compromised and the skin becomes dry and itchy. The best initial management is regular moisturizers (emollients). Applying thick, fragrance-free emollients immediately after bathing helps restore the protective barrier and prevent transepidermal water loss, which reduces drying and itching. This approach addresses the underlying problem rather than just the symptoms.

If itching and inflammation persist, clinicians may add a low-potency topical corticosteroid for short periods to control flares, but the first step is always good barrier repair with moisturizers. Wet wrap therapy is reserved for more severe or widespread flares, and oral antihistamines have limited impact on the dermatitis itself in infants.