From the Guidelines
Treatment for pediatric foot contact dermatitis should involve identifying and removing the triggering allergen or irritant, followed by appropriate medication, with a focus on low-potency topical corticosteroids and moisturizers to minimize side effects and promote skin barrier repair. According to the guidelines for the management of contact dermatitis 1, it is essential to recognize the different types of contact dermatitis, including irritant, allergic, phototoxic, photoallergic, and systemic contact dermatitis. For mild cases, low-potency topical corticosteroids like hydrocortisone 1% cream can be applied thinly twice daily for 7-10 days.
Some key considerations in managing pediatric foot contact dermatitis include:
- Identifying and avoiding the specific trigger, which can include shoe materials, dyes, adhesives, or certain fabrics
- Using moisturizers like petroleum jelly or ceramide-containing creams to repair the skin barrier
- Applying oral antihistamines like cetirizine to manage itching, with dosing based on the child's weight
- Keeping the affected area clean and dry, avoiding harsh soaps, and having the child wear cotton socks and well-ventilated shoes
- Considering topical antibiotics like mupirocin for infected dermatitis
It is crucial to consult a pediatric dermatologist for patch testing to identify specific allergens if symptoms persist beyond 2 weeks despite treatment, worsen, or recur frequently 1. The guidelines emphasize the importance of recognizing recreational and occupational factors in irritant and allergic dermatitis, which can inform treatment and prevention strategies 1.
From the FDA Drug Label
Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily children under 2 years of age: ask a doctor children under 12 years of age: ask a doctor
For the treatment of foot contact dermatitis in pediatric patients, hydrocortisone (TOP) can be applied to the affected area not more than 3 to 4 times daily for children 2 years of age and older 2.
- For children under 2 years of age, a doctor should be consulted before use.
- For children under 12 years of age, a doctor should be consulted before use. Triamcinolone acetonide (TOP) can be used for pediatric patients but with caution due to the risk of HPA axis suppression and Cushing's syndrome 3.
- Administration of topical corticosteroids to children should be limited to the least amount compatible with an effective therapeutic regimen.
- Chronic corticosteroid therapy may interfere with the growth and development of children.
From the Research
Treatment for Foot Contact Dermatitis in Pediatrics
- The treatment for foot contact dermatitis in pediatric patients typically involves avoidance of the offending allergen, once identified 4, 5.
- Medical therapies may include topical corticosteroids and topical immunomodulators 4.
- In severe cases, oral corticosteroids or immunomodulators may be utilized, although prospective randomized trials for the treatment of this disease in children are lacking 4.
- Patch testing remains the gold standard in diagnosis and can help identify the causative allergen 4, 6, 5, 7.
- Common causative agents in children include metals, fragrances, and certain preservatives 6, as well as nickel, cobalt, neomycin, and others 7.
Management of Contact Dermatitis
- The first step in confirming the diagnosis is determining whether the problem resolves with avoidance of the substance 8.
- Localized acute allergic contact dermatitis lesions can be successfully treated with mid- or high-potency topical steroids 8.
- Systemic steroid therapy may be required for extensive areas of skin involvement 8.
- Patch testing should be performed if treatment fails and the diagnosis or specific allergen remains unknown 8, 5, 7.
Importance of Early Diagnosis
- Early diagnosis of allergic contact dermatitis in children is considered very important 5.
- Persistent, well-localized, and recurrent eczematous lesions in children should suggest an allergic contact dermatitis, inducing physicians to refer patients for patch testing 5.
- Physicians should be acquainted with the current trends and the emerging contact allergens in children to provide the best treatment, management, and prevention 5, 7.