What are the home care instructions and follow-up recommendations for a child with unknown contact dermatitis who received Decadron (dexamethasone) and Benadryl (diphenhydramine) in the office?

Home Care Instructions and Follow-Up for Pediatric Contact Dermatitis

Immediate Home Management

Continue aggressive moisturization immediately after any hand washing or bathing, applying fragrance-free moisturizers with petrolatum or mineral oil to damp skin at least 3-4 times daily. 1

Skin Care Routine

• Apply moisturizer within 3 minutes of bathing using the "pat dry then moisturize" technique—gently pat skin dry rather than rubbing, then immediately apply moisturizer to damp skin 1, 2
• Use two fingertip units of moisturizer for adequate hand coverage if hands are affected 1
• For severe dryness, use the "soak and smear" technique nightly: soak affected area in plain lukewarm water for 20 minutes, then immediately apply moisturizer to damp skin for up to 2 weeks 1, 3
• Consider applying moisturizer followed by cotton gloves at night to create an occlusive barrier for enhanced healing 2

Bathing and Cleansing Practices

• Use lukewarm or cool water only—never hot water, which damages the skin barrier 1, 4
• Choose soaps or synthetic detergents without fragrances, dyes, or preservatives, preferably with added moisturizers 2, 1
• Avoid harsh soaps, dish detergents, and disinfectant wipes on the child's skin 2, 4
• Limit bath time to 5-10 minutes to prevent excessive drying 1

Critical Allergen/Irritant Avoidance

The most important step is identifying and completely avoiding the causative substance—keep a detailed diary of everything that touches the affected skin area for the next 2 weeks. 2, 5

Detective Work for Parents

Document exposure to these common pediatric allergens: 2

• Nickel (jewelry, belt buckles, snaps on clothing)
• Fragrances (lotions, soaps, laundry detergents, fabric softeners)
• Preservatives in personal care products
• Topical antibiotics (neomycin, bacitracin in ointments)
• Rubber chemicals (shoes, toys, elastic in clothing)
• Adhesive bandages containing benzalkonium chloride or bacitracin 2

Specific Avoidance Measures

• Switch to fragrance-free laundry detergent and avoid fabric softeners 1
• Remove any jewelry, especially nickel-containing items 2
• Avoid applying any topical antibiotics or "triple antibiotic ointment" to the rash 2
• Do not use superglue on any cracks or fissures that develop 2, 4

Monitoring for Medication Side Effects

Watch carefully for worsening despite treatment—paradoxically, the child could be allergic to the Benadryl (diphenhydramine) itself, which can cause contact dermatitis. 6, 7

Warning Signs Requiring Immediate Contact

Contact the provider immediately if: 3, 8

• Rash worsens or spreads despite treatment
• Development of fever, oozing, crusting, or honey-colored drainage (signs of secondary infection)
• Severe itching interfering with sleep despite Benadryl
• Any facial swelling, difficulty breathing, or systemic symptoms

Antihistamine Use at Home

• Continue oral diphenhydramine (Benadryl) as prescribed for itching control, typically 1 mg/kg/dose every 6 hours as needed (maximum 50 mg/dose) 8
• Give at bedtime to help with sleep disruption from itching 8
• Stop immediately and call provider if new rash develops after starting Benadryl, as diphenhydramine itself can cause allergic contact dermatitis 6

Expected Timeline and Follow-Up

Schedule follow-up in 5-7 days if not improving, or in 2 weeks for reassessment even if improving. 1, 5

What to Expect

• Improvement should begin within 12-24 hours of steroid administration 5
• Complete resolution typically takes 1-2 weeks with proper allergen avoidance and skin care 3, 5
• If no improvement after 2 weeks, patch testing will be needed to identify the specific allergen 3, 5

Reasons for Earlier Follow-Up

Return sooner (within 2-3 days) if: 1, 8

• No improvement or worsening despite treatment
• Signs of infection develop
• Rash spreads to new areas
• Severe discomfort not controlled by current medications

When Dermatology Referral Is Needed

If the rash persists beyond 6 weeks or recurs after initial improvement, referral to pediatric dermatology for patch testing is essential to identify the specific allergen. 2, 1, 5

Patch testing indications include: 2

• Recurrent or persistent dermatitis despite appropriate treatment
• Unclear trigger after detailed history
• Hand or eyelid involvement in children (high suspicion for allergic contact dermatitis)
• Need to identify specific allergen for complete avoidance

Common Pitfalls to Avoid

Parents must avoid these mistakes that worsen contact dermatitis: 2, 1, 4

• Frequent hand washing with soap (if hands affected)—rinse with water only when possible
• Applying the child's regular lotions—many contain fragrances or preservatives that perpetuate the problem
• Using adhesive bandages on the rash (contain potential allergens)
• Bathing in hot water or bubble baths
• Rubbing or scratching the affected area—keep child's nails trimmed short