From the Guidelines
The treatment for Papular Acrodermatitis of Childhood (PACD) should focus on symptom management, particularly for itching, with the use of topical corticosteroids and oral antihistamines, as recommended by the most recent guidelines 1.
Treatment Approach
The approach to treating PACD involves managing the symptoms, especially itching, to improve the patient's quality of life.
- Topical corticosteroids, such as hydrocortisone 1% cream, can be applied twice daily to affected areas to provide relief from itching.
- Oral antihistamines like cetirizine (5-10mg once daily) or diphenhydramine (25-50mg every 6 hours) can help control pruritus.
- Cool compresses and lukewarm oatmeal baths can soothe the skin.
- Patients should avoid hot water, harsh soaps, and scratching, which can worsen symptoms.
- Emollients like petroleum jelly or fragrance-free moisturizers should be applied regularly to keep the skin hydrated.
Considerations
PACD is often associated with viral infections, so treating any underlying infection may be necessary. The condition causes characteristic papular eruptions on the face, buttocks, and extremities due to an immune response to the viral trigger, explaining the widespread distribution of the itchy lesions. Reassurance about the benign and self-resolving nature of the condition is an important part of management. According to the guidelines for managing immune-related adverse events in patients treated with immune checkpoint inhibitor therapy 1, the management of pruritus can be based on its grade, with topical emollients and mild-moderate potency topical corticosteroids recommended for grade 1, and oral antihistamines and medium-to-high potency topical corticosteroids for grade 2. For more severe cases, as outlined in the guidelines for the management of atopic dermatitis 1, oral corticosteroids may be considered, but their use should be carefully weighed against potential side effects. The British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis 1 also emphasize the importance of treating underlying conditions and using topical and oral treatments as necessary to manage pruritus. However, the most recent and highest quality study 1 provides the most relevant guidance for the treatment of PACD, prioritizing symptom management and quality of life.
From the Research
Treatment for PACD
The treatment for Primary Angle Closure Disease (PACD) typically involves a laser iridotomy, which is a commonly necessary but sometimes insufficient procedure 2.
- The main considerations after iridotomy are:
- Whether the angle is open or closed
- Whether the Intraocular Pressure (IOP) can be medically controlled
- The extent of Peripheral Anterior Synechiae (PAS)
- The presence of visually significant cataract
- Indications for subsequent interventions, such as iridoplasty, cataract surgery, trabeculectomy, or phacotrabeulectomy, are based on the extent of angle opening and PAS following initial treatment 2.
Screening Techniques
Peripheral anterior chamber depth (ACD) measurement is recommended for PACD screening in community elderly Chinese 3.
- The distribution of peripheral ACD and its relationship with gonioscopy and other ocular parameters can help identify individuals at risk of PACD
- A peripheral ACD of less than 0.5 corneal thickness (CT) is considered a risk factor for PACD 3
Itching and PACD
There is no direct evidence linking itching to PACD treatment. However, antihistamines and corticosteroids are sometimes used to manage itching and other allergic reactions 4.
- These medications may be used to prevent hypersensitivity reactions, but their effectiveness in PACD treatment is not well established
- Topical noncorticosteroid immunomodulators, such as tacrolimus and pimecrolimus, may be used to treat atopic dermatitis, which can cause itching 5