From the Guidelines
The next best step in managing the child's persistent itchy rash is to try a different topical corticosteroid, such as triamcinolone 0.1%, and to add an oral antihistamine like cetirizine (5-10mg daily) to help control itching. The child has already been treated with hydrocortisone 1% and fucidin without improvement, suggesting the need for a different approach 1. It's also important to consider the possibility of a secondary bacterial infection or contact dermatitis, which may require additional treatment 1.
Some key considerations in managing the child's rash include:
- Avoiding potential irritants, including harsh soaps, fragranced products, and rough clothing
- Keeping the child's fingernails short to prevent skin damage from scratching
- Considering a trial of dietary manipulation if the child's history suggests a specific food allergy or if the rash is not responding to first-line treatment 1
- Ruling out other potential causes of the rash, such as a contact dermatitis or an allergic reaction to a medication or environmental factor
It's also important to note that the evidence for the therapeutic value of evening primrose oil remains inconclusive, and its use is not currently recommended as a first-line treatment for atopic eczema 1. If the rash persists or worsens despite treatment, or if the child develops signs of infection or other concerning symptoms, it's essential to consult a healthcare provider promptly for further evaluation and guidance.
From the FDA Drug Label
Temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: • runny nose • itchy, watery eyes • sneezing • itching of the nose or throat
The symptoms described do not directly match the uses listed for loratadine.
- The child's rash is itchy, but it is not specified as being due to hay fever or other upper respiratory allergies.
- The rash is described as multiple small pin point spots on the chest, back, and cheeks, which is not explicitly mentioned in the drug label. Given the information provided and the lack of direct relevance to the child's symptoms, the best next step is unclear based on the provided drug label 2.
From the Research
Next Steps in Managing the Child's Rash
The child's rash is described as itchy with multiple small pin point spots of different sizes, a few millimeters in diameter, on the chest, back, and cheeks, with no erythema. Given that hydrocortisone 1% with fucidin has not helped, the next steps could involve considering alternative treatments for the itch and rash.
Considerations for Treatment
- The use of antihistamines may be considered for relieving itch, but the choice of antihistamine is crucial.
- First-generation antihistamines like diphenhydramine have been shown to have a higher adverse side-effect profile, especially in children and older adults 3.
- Topical antihistamines, including diphenhydramine, have mixed evidence supporting their use for pruritus relief, with the exception of topical doxepin which has been demonstrated to reduce pruritus 4.
- Second-generation antihistamines, such as loratadine, have been shown to have fewer adverse effects on the central nervous system compared to first-generation antihistamines, making them a potentially safer option for children 5.
Alternative Approaches
- Given the lack of response to initial treatment, it may be necessary to reassess the diagnosis and consider other causes of the rash.
- There is limited direct evidence from the provided studies to guide the next steps in managing this specific condition.
- However, the principle of using treatments with a stronger evidence base and fewer side effects is a reasonable approach.
Further Evaluation
- Further evaluation of the child's condition may be necessary to determine the underlying cause of the rash and to guide treatment decisions.
- Consultation with a specialist, such as a dermatologist or allergist, may be helpful in determining the best course of action.