Hydrocortisone acetate alone or combined with mupirocin for atopic dermatitis in infants under two years of age - a randomized double blind pilot trial

Eur Rev Med Pharmacol Sci. 2012 Dec;16(14):1989-93.


Background: The skin of patients with atopic dermatitis (AD) is heavily colonized with Staphylococcus (S.) aureus, even at uninvolved sites. Toxins secreted by the majority of S. aureus on the skin behave as superantigens and can directly influence the disease activity, although clinical signs of bacterial superinfection might be absent.

Objectives: This study was conducted to compare the efficacy of hydrocortisone cream, combined with mupirocin or alone with emmolient ointment for the treatment of mild to moderate AD in infants between six months and two years of age.

Materials and methods: A total of 83 patients with mild to moderate AD were randomized to receive hydrocortisone, hydrocortisone+ mupirocin or emmolient ointment twice daily in one week and followed-up for 8 weeks, in a blind study. Efficacy evaluation made by SCORAD and eczema area and severity index (EASI) at baseline, day 7, and weeks 2, 4, and 8. Possible adverse events were recorded to evaluate safety.

Results: At the end of study, 65% (17 of 26) of the patients were treated successfully with hydrocortisone ointment based on SCORAD and EASI scores. Also there was a significant improvement in patients combined with mupirocin ointment [74% (20 of 27)]. The percent improvement from baseline in EASI scores was also significantly greater in hydrocortisone and combined group compared with emmolient-treated patients (36%) (p = 0.0187, p = 0.012 respectively).

Conclusions: Monotherapy with hydrocortisone ointment is the main treatment in infants with mild to moderate AD and combination with mupirocin is safe and effective often needed because of possible Staphylococcus carriage.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Cutaneous
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use*
  • Dermatitis, Atopic / drug therapy*
  • Dermatitis, Atopic / microbiology
  • Dermatitis, Atopic / pathology
  • Double-Blind Method
  • Drug Therapy, Combination
  • Emollients / administration & dosage
  • Emollients / adverse effects
  • Emollients / therapeutic use*
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydrocortisone / adverse effects
  • Hydrocortisone / analogs & derivatives*
  • Hydrocortisone / therapeutic use
  • Infant
  • Mupirocin / administration & dosage
  • Mupirocin / adverse effects
  • Mupirocin / therapeutic use*
  • Ointments
  • Pilot Projects
  • Severity of Illness Index
  • Skin / drug effects*
  • Skin / microbiology
  • Skin / pathology
  • Staphylococcal Skin Infections / drug therapy*
  • Staphylococcal Skin Infections / microbiology
  • Staphylococcal Skin Infections / pathology
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / isolation & purification
  • Time Factors
  • Treatment Outcome
  • Turkey


  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Emollients
  • Ointments
  • hydrocortisone acetate
  • Mupirocin
  • Hydrocortisone