Contact%20dermatitis%20(pediatric) Treatment
Principles of Therapy
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)
Pharmacotherapy
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
Non-Pharmacological Therapy
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