contact%20dermatitis%20(pediatric)
CONTACT DERMATITIS (PEDIATRIC)
Allergic contact dermatitis is an immunologic cell-mediated skin reaction to exposure to antigenic substances.
The lesions initially appear on the cutaneous site of principal exposure then may spread to other more distant sites due to contact or autosensitization. Lesions are typically asymmetrical and unilateral.
Specific signs and symptoms will depend on the duration, location, degree of sensitivity and concentration of allergens. The patch test shows reaction to allergen.
Irritant contact dermatitis is a non-immunologic skin reaction to skin irritants.
It is often localized to areas of thin skin eg eyelids, intertriginous areas.

Principles of Therapy

Identify & Eliminate Trigger Factors

  • Allergic contact dermatitis (ACD): Patient should avoid allergens & all cross-reactants completely
    • Review where the allergen is found & discuss safe replacements
  • Irritant contact dermatitis (ICD): Patient should avoid prolonged contact w/ irritants
    •  Eg frequent diaper changes & use of disposable diapers w/ super-absorbent material
  • When allergen cannot be avoided, use personal protection (eg protective gloves, clothing)

Pharmacotherapy

Allergic Contact Dermatitis (ACD)

Corticosteroids (Topical/Oral)

  • Actions: Anti-inflammatory & immunosuppressing effects by decreasing the production of cytokines & 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

Others

  • Antibiotics1 (topical/oral)
    • May be needed in cases associated w/ secondary infection
  • Other treatments being considered for steroid-resistant ACD include Cyclosporin, Azathioprine, & Psoralen plus polyvinyl alcohol (PVA)

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

Non-Pharmacological Therapy

Skin Care

  • Wash affected areas using mild soap & 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 to affected areas several times daily
  • Relieves symptoms & speeds healing of weeping lesions w/ exudates by gentle debridement, debris removal & evaporated cooling

Chronic Dermatitis

Emollients

  • Should be applied frequently, especially after contact w/ water or irritants
  • Provide an occlusive layer over inflamed skin, reduce evaporation & decrease fissuring
  • Patient preference & treatment area will determine formula used
    • Eg petrolatum, liquid paraffin, mineral oils, glycerine, etc
    • Avoid products w/ 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 w/ severe chronic allergic contact dermatitis (ACD)
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