From the Guidelines
For a child with pruritus and small bumps without a clear infectious cause, I recommend starting with gentle skin care and over-the-counter treatments, prioritizing bland, thick emollients and low- to mid-potency topical corticosteroids as needed, as suggested by the most recent and highest quality study 1. When managing pruritus in children, it's essential to consider the potential causes and the most effective treatment options. The study published in Pediatrics in 2021 1 provides guidance on the care of congenital melanocytic nevi in newborns and infants, including the management of pruritus.
- Key points to consider:
- Use mild, fragrance-free cleansers like Cetaphil or CeraVe when bathing
- Apply a moisturizer immediately after bathing while the skin is still damp
- For itch relief, consider oral antihistamines such as cetirizine (Zyrtec) or diphenhydramine (Benadryl) as needed
- Topical treatments like 1% hydrocortisone cream can be applied to itchy areas twice daily for up to 7 days
- Avoid potential irritants, including harsh soaps, fragranced products, and rough clothing
- Keep fingernails short to prevent skin damage from scratching Other studies, such as those published in the Journal for ImmunoTherapy of Cancer in 2017 1, Annals of Oncology in 2021 1, and British Journal of Dermatology in 2018 1, provide additional guidance on managing pruritus, but the most recent and highest quality study 1 should be prioritized. It's crucial to monitor the child's symptoms and adjust the treatment plan as needed. If symptoms don't improve within 1-2 weeks, if there's significant sleep disruption, or if the rash spreads or worsens, consult a healthcare provider for further evaluation. These symptoms could represent various conditions, including atopic dermatitis, contact dermatitis, or a mild allergic reaction, and the initial management focuses on symptom relief while avoiding further skin irritation.
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 Purpose Anti-itch
For a child with pruritus and small bumps all over the body, without a clear diagnosis of an infectious cause, hydrocortisone (TOP) may be considered for treatment of itching.
- For children 2 years of age and older, apply hydrocortisone (TOP) to the affected area not more than 3 to 4 times daily 2.
- For children under 2 years of age, a doctor should be consulted before using hydrocortisone (TOP) 2.
- For children under 12 years of age, a doctor should be consulted before using hydrocortisone (TOP) for external anal and genital itching 2.
From the Research
Treatment Options for Pruritus and Small Bumps
- The treatment for a child with pruritus and small bumps all over the body, without a clear diagnosis of an infectious cause, may involve the use of antihistamines, such as fexofenadine, in combination with topical corticosteroids 3, 4.
- Antihistamines, particularly sedating antihistamines, are often used to treat pruritus associated with atopic dermatitis, despite limited evidence for their efficacy 5.
- A systematic review and meta-analysis found that the combination of H1-antihistamines and topical steroids had a synergistic effect in reducing pruritus in atopic dermatitis 3.
- A study found that the addition of fexofenadine to a topical corticosteroid reduced the pruritus associated with atopic dermatitis in a 1-week randomized, multicentre, double-blind, placebo-controlled, parallel-group study 4.
Considerations for Diagnosis and Treatment
- It is essential to consider the entire clinical presentation, including the appearance and location of the rash, clinical course, and associated symptoms, such as pruritus or fever, to make an accurate diagnosis 6.
- Pruritus can occur with various skin conditions, including atopic dermatitis, pityriasis rosea, erythema infectiosum, molluscum contagiosum, and tinea infection 6.
- The American Academy of Dermatology does not recommend the general use of antihistamines in the management of atopic dermatitis, although the value of short-term sedating antihistamine use for insomnia secondary to itch is recognized 5.