What is the treatment for contact dermatitis in pediatric patients?

From the Guidelines

The treatment for contact dermatitis in pediatric patients should prioritize removing the irritant or allergen, using gentle moisturizers, and applying over-the-counter 1% hydrocortisone cream for up to 7 days to reduce inflammation, as recommended by recent guidelines 1. The goal of treatment is to reduce inflammation, prevent infection, and minimize discomfort. Key steps include:

• Identifying and removing the irritant or allergen causing the reaction
• Applying cool compresses to the affected area for 15-20 minutes several times daily
• Using gentle, fragrance-free moisturizers like petroleum jelly or ceramide-containing creams after bathing
• Applying over-the-counter 1% hydrocortisone cream thinly to affected areas twice daily for up to 7 days to reduce inflammation
• Using children's diphenhydramine (Benadryl) according to weight-based dosing on the package for itching For moderate to severe cases, a pediatrician may prescribe stronger topical steroids like triamcinolone 0.1% or fluticasone 0.05% cream, or in extensive cases, a short course of oral steroids like prednisolone, as suggested by older guidelines 1. However, the most recent and highest quality study 1 should be prioritized when making treatment decisions. Additional measures to prevent further irritation include:
• Keeping the child's fingernails short to prevent scratching and infection
• Using fragrance-free laundry detergent
• Dressing the child in loose cotton clothing to avoid further irritation
• Considering wet wrap therapy for severe cases, which involves applying medication, covering with wet gauze, then a dry layer for 2-3 hours or overnight.

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 pediatric patients with contact dermatitis, the treatment is to apply hydrocortisone (TOP) to the affected area not more than 3 to 4 times daily for children 2 years of age and older. For children under 2 years of age or under 12 years of age, a doctor should be consulted for advice 2.

From the Research

Treatment Options for Contact Dermatitis in Pediatric Patients

• The primary treatment for contact dermatitis involves avoiding the offending agent 3
• In cases where avoidance is not possible, therapy is focused on reducing the inflammatory component and its symptoms 3
• Established treatment options for contact dermatitis include corticosteroids and dietary manipulation 3
• New therapies, such as immunomodulatory and anti-inflammatory agents, have also shown promise in treating contact dermatitis 3

Management of Contact Dermatitis in Children

• Contact dermatitis is a common skin condition in children, with metals, fragrances, and preservatives being common causative agents 4
• Diagnosis typically requires patch testing, along with a detailed history and physical examination 4
• Management of contact dermatitis in children involves a stepped approach to therapy, starting with emollients and adding topical medications as needed 5

Use of Topical Corticosteroids in Pediatric Patients

• Topical corticosteroids are a common treatment for atopic dermatitis in children, with a wide range of potency classes and formulations available 6
• The therapeutic efficacy of topical corticosteroids depends on selecting the appropriate vehicle and potency, as well as the frequency and duration of application 6
• Methylprednisolone aceponate is a potent fourth-generation corticosteroid that has demonstrated efficacy and safety in treating atopic dermatitis in infants and children 5

Guidance for Industry on Developing Drugs for Atopic Dermatitis in Children

• The Food and Drug Administration has issued draft guidance for industry on developing drugs for the treatment of atopic dermatitis in children 7
• This guidance aims to standardize clinical development and trial design for children with atopic dermatitis, and provides recommendations for optimal therapy for severe disease 7