Contact%20dermatitis%20(pediatric) Treatment

Identify and Eliminate Trigger Factors

• Allergic contact dermatitis (ACD): Patient should avoid allergens and all cross-reactants completely
  
  • Review where the allergen is found and discuss safe replacements

• Irritant contact dermatitis (ICD): Patient should avoid prolonged contact with irritants
  • Eg frequent diaper changes and use of disposable diapers with super-absorbent material
  • Avoid compulsive and excessive hand washing
  • Advocate good ventilation and regular drying of feet if with excessive sweating or water exposure of feet
  • Avoid habitual lip-licking

• When allergen cannot be avoided, use personal protection (eg protective gloves, clothing)

Allergic Contact Dermatitis (ACD)

Corticosteroids (Topical/Oral)

• Actions: Anti-inflammatory and immunosuppressing effects by decreasing the production of cytokines and stopping lymphocyte production
• Topical corticosteroids
  
  • Effects: Usually effective for most cases of ACD
  • 1st-line agents for isolated lesions
  • Moderately potent products are usually sufficient for acute dermatitis
  • Potent products may be required for persistent dermatitis or chronic dermatitis

• Oral corticosteroids
  
  • Recommended in patients who have >20-30% of their body surface area (BSA) affected, systemic ACD or exposure to allergens that cause symptoms to persist
  • Effects: Rapid symptomatic relief of ACD

Antihistamines (Oral)

• Effects: Help to relieve pruritus
  
  • If sedating antihistamine is used, it will help the patient to sleep through the night

Calcineurin Inhibitors (Topical)

• Eg Pimecrolimus, Tacrolimus
• Alternative treatment option for patients intolerant or unresponsive to topical corticosteroids, patients with chronic localized ACD, topical corticosteroid-induced ACD, and patients with ACD involving the face or intertriginous areas

Others

• Antibiotics¹ (topical/oral)
  
  • May be needed in cases associated with secondary infection
• Other treatments being considered for steroid-resistant ACD include Ciclosporin, Azathioprine, and phototherapy [Psoralen plus UVA (PUVA) or narrowband UVB which has less side effects]

Irritant Contact Dermatitis (ICD)

Corticosteroids (Topical)

• 1st-line agents for isolated lesions
• Moderately potent products are usually sufficient for acute dermatitis
• Potent products may be required for persistent dermatitis or chronic dermatitis

Antihistamines (Oral)

• Effects: Help to relieve pruritus
  
  • If sedating antihistamine is used, it will help the patient to sleep through the night

Others

• Antibiotics¹ (topical/oral)
  
  • May be needed in cases of secondary infection

¹Various products are available. Please see prescribing information for specific formulations in the latest MIMS

Skin Care

• Wash affected areas using mild soap and lukewarm water
  
  • Oatmeal products added to bath may also relieve symptoms
• Use appropriate barrier creams

Acute/Subacute Dermatitis

Wet Dressings

• Apply absorbent material dressings soaked in Al acetate or saline solution to affected areas several times daily
• Relieves symptoms and speeds healing of weeping lesions with exudates by gentle debridement, debris removal and evaporated cooling

Chronic Dermatitis

Emollients

• Should be applied frequently, especially after contact with water or irritants
• Provide an occlusive layer over inflamed skin, reduce evaporation and decrease fissuring
• Patient preference and treatment area will determine formula used
  
  • Eg petrolatum, liquid paraffin, mineral oils, glycerin, etc
  • Avoid products with high water content, preservatives or fragrances

Severe Chronic Allergic Contact Dermatitis (ACD)

Phototherapy

• Narrow-band ultraviolet B (UVB) or psoralen ultraviolet A (PUVA) may be used in patients with severe chronic ACD
• Treatment option for patients with chronic ACD and unresponsive to topical or oral corticosteroids