Current Strategies in Treating Severe Contact Dermatitis in Pediatric Patients

Abstract

Allergic contact dermatitis in children is underdiagnosed and undertreated, and its incidence is increasing. Appropriate history taking and the suspicion for allergic contact dermatitis is essential, and patch testing remains the gold standard in diagnosis. Avoidance of the offending allergen, once identified, is the first goal of treatment. Medical therapies include topical corticosteroid and topical immunomodulators. In severe cases, oral corticosteroids or immunomodulators are utilized, although prospective randomized trials for the treatment of this disease in children are lacking. A PubMed literature search was performed to identify publications on allergic contact dermatitis in the pediatric population with the keywords: dermatitis, children, allergic contact dermatitis, pediatrics, contact hypersensitivity, contact allergy, treatment, and management. This review will address the major principles behind the diagnosis and management of this disease in the pediatric population, and highlight useful strategies that may result in improved treatment of this condition.

Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications

“…When triggers cannot be identified/avoided or there is residual dermatitis after triggers have been removed, TCS [25,26] or TCIs [27,28,29] may reduce inflammation; however, chronic use of TCS should be avoided, especially on the face and diaper area. Long term and frequent (greater than once daily) application of TCS (especially higher potency preparations) is contraindicated, due to an increased risk of skin barrier compromise and systemic exposure.…”

Contact dermatitis: a comparative and translational review of the literature

“…Obtaining a complete history is crucial for the diagnosis of CD. Relevant information includes clinical evolution of initial lesions, time of onset, potential sources of exposure to irritants/allergens (including occupational exposure for humans) and history of previous CD event . Additional information that should be obtained includes the number of affected individuals in the household, recent changes in environment and new topical therapies .…”

“…However, a controlled study on sodium lauryl sulfate (SLS)‐induced ICD in humans showed no difference between topical corticosteroids (0.1% hydrocortisone or 1% betamethasone, both applied once on the first day and twice daily for the next 4 days), vehicle cream and untreated controls . Topical glucocorticoids are the first line of treatment for human patients with ACD and are commonly used in veterinary patients as well . One human study showed that subjects improved overall compared to vehicle‐treated sites when topical steroids (triamcinolone acetonide 0.1% ointment or clobetasol proprionate 0.05% ointment) were applied; however, the improvement was not significant .…”

“…The most common adverse effects of topical corticosteroids in humans are facial acne, striae and dyschromia . Systemic corticosteroids may cause polyphagia, polydipsia and polyuria in addition to hypotrichosis, hypertension, diabetes and iatrogenic hypercortisolism . Furthermore, it has been reported that the response to topical and systemic corticosteroids seems to decrease over time with chronic use …”

Contact Dermatitis: Therapeutics When Avoidance Fails

“…A meta-analysis evaluating 17 trials comparing tacrolimus 0.03% and 0.1% ointment with TCS in pediatric patients and adult patients with atopic dermatitis concluded that tacrolimus 0.1% ointment is similar in efficacy to potent TCS [16]. The experience with atopic dermatitis may be extrapolated to patients with contact dermatitis [17].…”