What is the recommended dexamethasone (corticosteroid) dosage for an 18-month-old child with contact dermatitis?

Dexamethasone Dosage for Contact Dermatitis in an 18-Month-Old Child

For an 18-month-old child with contact dermatitis, topical corticosteroids are the first-line treatment, and oral dexamethasone should be reserved only for severe cases at a dose of 0.15 mg/kg as a single dose.

First-Line Treatment Approach

Topical Corticosteroids

• Low to medium potency topical corticosteroids should be used first for contact dermatitis in an 18-month-old
• Apply once or twice daily until significant improvement is seen 1
• Recommended potency:
  • Face, neck, and skin folds: Low potency (Class 6-7) corticosteroids
  • Trunk and extremities: Low to medium potency (Class 4-5) corticosteroids

Application Guidelines

• Apply a thin layer to affected areas
• Duration: Short courses (5-7 days) to minimize adverse effects
• Avoid occlusive dressings in infants unless specifically indicated
• Consider wet-wrap therapy for moderate to severe cases (maximum 3-7 days) 1

Systemic Corticosteroids (For Severe Cases Only)

Oral Dexamethasone Dosing

• Single dose: 0.15 mg/kg (minimum 2-4 mg) 2
• This is the recommended pediatric dose for acute inflammatory conditions
• For severe, widespread contact dermatitis unresponsive to topical therapy

Important Considerations for Systemic Therapy

• Limit systemic corticosteroid use to shortest duration possible
• Monitor for adverse effects:
  • Hyperglycemia
  • Hypertension
  • Increased risk of infection
  • Growth parameters 2

Adjunctive Treatments

Emollients

• Apply immediately after bathing
• Regular use has steroid-sparing effects 1
• Apply 2-3 times daily to maintain skin barrier

Antihistamines

• Consider for severe pruritus
• Age-appropriate dosing of non-sedating antihistamines during daytime
• Sedating antihistamines may be used at night if sleep is disturbed

Treatment Algorithm

1. Mild to moderate contact dermatitis:

   • Low to medium potency topical corticosteroid twice daily for 5-7 days
   • Regular emollient use
   • Identify and remove triggering allergen

2. Moderate to severe contact dermatitis:

   • Consider wet-wrap therapy with topical corticosteroids for 3-7 days
   • Add antihistamines for pruritus

3. Severe, widespread, or unresponsive contact dermatitis:

   • Single dose oral dexamethasone 0.15 mg/kg
   • Continue topical therapy
   • Close follow-up within 24-48 hours

Monitoring and Follow-up

• Reassess within 48-72 hours for treatment response
• Monitor for adverse effects of topical steroids:
  • Skin atrophy
  • Telangiectasia (particularly on face) 3
• If using systemic corticosteroids, monitor:
  • Blood pressure
  • Blood glucose
  • Signs of infection

Cautions and Pitfalls

• Avoid high-potency topical corticosteroids in infants due to increased risk of adrenal suppression 1
• Limit duration of topical steroid use to minimize risk of skin atrophy
• Be aware that infants have higher body surface area to weight ratio, increasing systemic absorption of topical medications
• Prolonged use of dexamethasone in infants has been associated with adverse developmental outcomes 4
• Consider the possibility of secondary bacterial infection which may require antibiotic treatment

Remember that identifying and removing the offending allergen is the most important aspect of managing contact dermatitis 5. Treatment should focus on controlling inflammation while the skin heals after allergen removal.