Pediatric Contact Dermatitis Medication

Therapy depends on the etiology and severity of contact dermatitis. Mild-to-moderate acute allergic contact dermatitis responds to topical care with astringents in a wet compress, topical corticosteroids, and systemic antipruritics. Acute severe allergic contact dermatitis with marked edema and bullae should receive the same treatment but may also require the addition of systemic corticosteroids.

Chronic allergic contact dermatitis should be treated with midpotency topical corticosteroids and general skin care with emollients.

Class Summary

These agents are used to reduce pain, pruritus, and serous drainage in acute weeping contact dermatitis.

Aluminum acetate solution (Burow solution, Domeboro)

Moist compresses are soothing, have a mild antipruritic effect, reduce serous drainage, and gently débride the wound. They are effective in the early stages of acute contact dermatitis when serous drainage is most severe.

Class Summary

These agents may be used as adjunctive treatment to moisturize dry skin in subacute and chronic contact dermatitis.

Eucerin, Lubriderm, Moisturel, Vaseline Intensive Care

Numerous emollients are available as creams, ointments, or lotions. Use ointments on dry or cracked skin and creams on inflamed or weeping lesions. Most patients prefer creams. These may be helpful in subacute and chronic contact dermatitis because they help add moisture to skin, minimize moisture loss, or both.

Class Summary

These agents may be used as adjunctive therapy to relieve pruritus. They are used to treat minor allergic reactions and anaphylaxis and may be used to pretreat patients with prior documentation of minor allergic reactions. These agents may control itching by blocking effects of endogenously released histamine.

Hydroxyzine HCl (Vistaril)

Hydroxyzine antagonizes H1 receptors in the periphery. It may suppress histamine activity in subcortical region of the central nervous system. This agent is available in 10 mg/5 mL syrup and as 10- and 25-mg tablets.

Diphenhydramine (Benadryl, Allerdryl)

Diphenhydramine is used for symptomatic relief of allergic symptoms caused by released histamine.

Class Summary

These agents decrease the inflammatory reaction associated with allergic contact dermatitis.

Triamcinolone topical (Triderm, Kenalog)

Use ointments on dry or cracked skin and creams on inflamed or weeping lesions. Most patients prefer creams. A moderate-potency topical corticosteroid, triamcinolone is available in both ointment (0.1%) and cream (0.1% or 0.5%). This agent decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.

Hydrocortisone topical (Cortaid, Dermarest, Westcort)

Lower-potency topical steroids such as hydrocortisone are useful on the face and intertriginous areas.

Class Summary

Low- or moderate-strength topical corticosteroids are useless as therapy for moderate-to-severe allergic contact dermatitis. Superpotent topical corticosteroids, such as clobetasol propionate (Temovate) or betamethasone dipropionate (Diprolene), applied 2-3 times daily for 1-2 weeks may be effective in small areas of acute allergic contact dermatitis or in lichenified areas of chronic contact dermatitis.

Clobetasol propionate (Temovate)

Clobetasol decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

Betamethasone dipropionate (Diprolene, Celestone, Luxiq)

Betamethasone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

Class Summary

These agents are reserved for severe cases of allergic contact dermatitis with involvement of more than 20% of the total body surface area (TBSA), significant bullae, or significant facial involvement. They have anti-inflammatory (glucocorticoid) and salt-retaining (mineralocorticoid) properties. Glucocorticoids cause profound and varied metabolic effects and modify the body's immune response.

Prednisone (Deltasone)

Approximately 7-10 d of therapy is usually adequate and does not require a tapering dosage schedule. Lesions occasionally recur following a course of therapy, and an additional few days of therapy may be required.

Prednisone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Prednisolone (Pedia-Pred, Delta-Cortef)

Prednisolone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Betamethasone sodium phosphate (Celestone) mixed with triamcinolone (Kenalog)

In adolescents and adults, an alternative to oral therapy is an IM dose of betamethasone sodium phosphate (Celestone) mixed with triamcinolone (Kenalog). This provides rapid onset and prolonged action over 2-4 weeks.

Class Summary

Barrier creams, such as zinc oxide or Desenex, are common effective agents to treat or prevent irritant diaper dermatitis. In the past, barrier creams or preexposure treatments offered little hope for protection from poison oak and ivy. However, new over-the-counter products, such as a lotion containing bentoquatam (IvyBlock), may offer some protection. Bentoquatam creates a clay-like barrier on the skin that protects against urushiol, the oily resin in poison ivy, oak, and sumac.

Bentoquatam is not a replacement for accepted protective devices, such as gloves, boots, and clothing. When exposure cannot be avoided completely, barrier products may protect areas of exposed skin, such as the neck and face.

Bentoquatam (Ivy block)

Zinc oxide provides relief of minor skin irritations and may provide a barrier against future exposures to irritants and allergens.