A 4-month-old male infant presents with a recurring rash on both cheeks for 4 days. The child appears nontoxic. What is the most appropriate treatment?

• A. Hydrocortisone
• B. Calcineurin inhibitor (tacrolimus)
• C. Oral antibiotics
• D. Antifungal cream

Answer: (A)

The situation points to a mild inflammatory skin condition of infancy, most consistent with atopic dermatitis (eczema) presenting on the cheeks. For a young infant with a mild, non-toxic appearance, the best initial treatment is gentle skin care plus a low-potency topical steroid to reduce inflammation and itching. Hydrocortisone 1% cream is appropriate here because it is sufficiently mild for facial use in infants and can quickly calm the redness and irritation when applied for a short period.

Other options aren’t first-line in this scenario. A calcineurin inhibitor like tacrolimus can be used for eczema but is typically avoided on an infant’s face as a first choice due to safety considerations and limited pediatric data. Oral antibiotics would be used only if there were signs of a secondary bacterial infection (which isn’t described). An antifungal cream would be chosen if there were evidence of a fungal infection, such as a persistent, itchy, ring-shaped rash or satellite lesions, which isn’t indicated by the description.

So, starting with hydrocortisone on the affected areas, along with gentle moisturizers and skin care, is the most appropriate initial approach.