From the Guidelines
For contact dermatitis in a 7-year-old, the primary treatment approach should involve identifying and removing the irritant or allergen causing the reaction, and using low-potency topical corticosteroids like 1% hydrocortisone cream for symptom relief, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1.
Key Considerations
- The cause of contact dermatitis is often multifactorial, and patients may have irritant and/or atopic/endogenous dermatitis in addition to allergic contact dermatitis 1.
- Patch testing is the gold-standard investigation in a patient in whom allergic contact dermatitis is considered, and should be considered if the cause remains unclear 1.
- Clinical assessment tools, such as the Dermatology Life Quality Index and the Hand Eczema Severity Index, should be used for both the initial assessment and the response to treatment of patients with contact dermatitis 1.
Treatment Approach
- Mild cases can be treated with cool compresses and calamine lotion for symptom relief.
- For moderate cases, use low-potency topical corticosteroids like 1% hydrocortisone cream applied thinly twice daily for 7-10 days.
- Avoid high-potency steroids on a child's thin skin, especially on the face or genital areas.
- Oral antihistamines, such as cetirizine (5mg once daily) or diphenhydramine (12.5-25mg every 6 hours, not exceeding 75mg daily), can help control itching.
Prevention and Follow-up
- Keep the affected area clean with gentle, fragrance-free soap and lukewarm water, and maintain good skin hydration with fragrance-free moisturizers applied several times daily.
- Dress the child in loose-fitting cotton clothing to avoid irritation.
- If the rash is severe, covers a large area, shows signs of infection, or doesn't improve within a week of treatment, consult a healthcare provider.
- Prevention is key, so once the trigger is identified, take steps to avoid future exposure and consider patch testing if the cause remains unclear.
From the FDA Drug Label
Children may absorb proportionally larger amounts of topical corticosteroids and thus be more susceptible to systemic toxicity. If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted. In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted.
The treatment guideline for contact dermatitis in a 7-year-old is to use topical corticosteroids with caution, as children may be more susceptible to systemic toxicity.
- Key considerations:
- Use the least potent corticosteroid necessary
- Avoid using occlusive dressings
- Monitor for signs of local adverse reactions and systemic toxicity
- Discontinue use if irritation develops or if there is no improvement with treatment 2
From the Research
Treatment Guideline for Contact Dermatitis in Children
The treatment for contact dermatitis in children involves several steps, including:
- Avoidance of the offending allergen or irritant, once identified 3, 4, 5, 6, 7
- Use of topical corticosteroids, such as triamcinolone 0.1% or clobetasol 0.05%, for localized acute allergic contact dermatitis lesions 3
- Systemic steroid therapy for extensive areas of skin involvement (greater than 20 percent) 3
- Patch testing to confirm the diagnosis and identify the causative allergen 3, 4, 5, 6, 7
- Use of emollients, antihistamines, and immunosuppressants to restore the skin barrier and reduce inflammation 5
Management of Severe Contact Dermatitis
In severe cases of contact dermatitis, oral corticosteroids or immunomodulators may be utilized 4. However, prospective randomized trials for the treatment of this disease in children are lacking 4. It is essential to taper oral prednisone over two to three weeks to prevent rebound dermatitis 3.
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment are crucial to prevent further deterioration and persistence of the skin condition 5, 6. Physicians should be aware of the current trends and emerging contact allergens in children to provide the best treatment, management, and prevention 6.