Contact Dermatitis (1 of 12)
Contact Dermatitis (1 of 12)
1 Patient presents w/ infl ammatory skin lesion suggestive of contact dermatitis
2 DIAGNOSIS Do history & physical No ALTERNATIVE examination confi rm DIAGNOSIS contact dermatitis?
Yes
PERFORM PATCH Positive TEST & EVALUATE Negative RESULT
Allergic contact dermatitis Irritant contact dermatitis (ACD) (ICD)
A Non-pharmacological therapy • Avoid trigger factors • Proper skin care Acute Dermatitis • Wet dressings - For acute weeping eruptions Chronic Dermatitis • Emollients - For lichenifi ed eruptions Severe Chronic ACD • Consider expert referral • B PhototherapyMIMS Pharmacological therapy • Corticosteroid (topical/oral) • Antihistamine (oral)
FOLLOWUP © See next page
Not all products are available or approved for above use in all countries. Specifi c prescribing information may be found in the latest MIMS.
B53 © MIMS Pediatrics 2020 CONTACT DERMATITIS • • ICD Chronic • ICD Acute • (ICD) Dermatitis Contact Irritant • ACD Systemic • • ACD Chronic • ACD Subacute • ACD Acute • • • • • (ACD) Dermatitis Contact Allergic • Hardening &adaptation contact ofthe skin may occur dueto repeated w/irritants &lichenifi cracked areChronic dry, lesions erythematous, ed fi vesicles, w/papules, &scaly areAcute erythematous lesions &erosionsssures on trigger factor depending feet) orthick skin(hands, areas) intertriginous ofthin skin(eg toareas eyelids, localized May be through exposure topical sensitized been previously towhich the patient chemical orfood has administration ofadrug, systemic by caused rash A generalized occur changes can Pigmentary are usuallylichenifiLesions fi scaling, ed, vesicles w/orwithout ssures patches &erythematous crusts, w/scales, prominent w/less Presents vesiculations, &bullae vesicles papules, Acute present eruptions w/macularerythema, toallergen reaction positive Patch shows test present featureA uniformly ispruritus allergens Specifi &concentration ofsensitivity onthe degree duration, depend location, of will &symptoms c signs &unilateral asymmetrical are typically Lesions to contact orautosensitization Initially, may toother spread exposure; siteofprincipal more onthe distant due cutaneous appear sites lesions substance (allergic contactcausing anallergic response dermatitis) An eczematouseruptionduetoexposureanirritatinglocalsubstance(irritantcontactdermatitis)orforeign 1 © • Avoidance oftrigger factors SIGNS & SYMPTOMS OF CONTACT DERMATITIS PREVENTION FOLLOWUP remission? Dermatitis Dermatitis Yes Contact Dermatitis(2of12) No
B54 MIMS • • warranted maytrigger factors be Further investigation of referral Consider expert - of allergens & reconfi sourcerm chemicals suspected Patch torelevant test © MIMS Pediatrics 2020 CONTACT DERMATITIS • A non-immunologic skin reaction to skin irritants; patch negative test Anon-immunologic toskinirritants; skinreaction • ICD • • • • • • Patch Test • ACD • • Agents Common Causative • • • • on: based factors trigger Determine TriggerDetermine Factors forACD/ICD Should only be done to children <6 years old w/ high degree of clinical suspicionforspecifi ofclinical donetochildrenShould oldw/highdegree only be <6 years c allergens correlated shouldbe w/patient’sResults history medical initialpatch done3-7days must reading after Second application be the removing tape/chamber tosettle after Allot another application 30minutes after forerythema application done48hoursafter shouldbe reading Result ACD egold standard fordiagnosing patch ofantigenic positive An immunologic cell-mediated toexposure test skinreaction substances; - Strong alkaline soaps, saliva, citrus juices, bubble bath, sweat, urine & feces (diaper &feces urine dermatitis), bubblebath, etc sweat, juices, citrus saliva, Strong alkalinesoaps, - ICD - ACD Avoid isactive, fl when ACD &coversaring >25%ofBSA - forICD test adiagnostic as Notrecommended - avoidance despite where persist therapy &topical symptoms oftrigger factors incases Recommended - Patch test - Date ofonset - the skincondition relationship &: Questioning between Physical examination Usually identifi agent the es sensitizing orallergens inonly10-20%ofcases - history Medical Management test Diagnostic manifestation Clinical Distribution Onset exposure Nature of response of Mechanism group Risk poos), etc poos), sham- liquid soaps, creams, protective (eg wipes, wet in infant products preservatives chemical sunscreens, stabilizers in skin products, fragrances, (nickel metals the common), being most foods, plants, Medications, © nickel-containing uniforms, items sports supplies, school pets, medications, w/dyes, clothing orfabrics sunscreens, products, skincare personal hygiene products, todiapers, Exposure therapy Nonpharmacologic &pharmacologic Complete avoidance ofallergens test patch orusage test onpositive Based Usually inacutephase Usually insubacute&chronic phase autosensitization dueto disseminated may be also band,wristband); (eg waist elastic exactly tocontactantMay correspond Usually hourstodays many exposures 1or after epoxy) formalin, metals, hapten wt orallergenmolecular (eg concentration low very be oflow Can reactions hypersensitivity Delayed Immunologic response: predisposed Genetically Contact Dermatitis(3of12) ACD 2 DIAGNOSIS
B55 MIMS therapy Nonpharmacologic &pharmacologic exposure incidence &reduced Protection of patch test ofavoidance ontrial ornegative Based irritant to w/exposure toarea Usually localized inchronicIndistinct borders ICD inacuteICD Distinct borders Usually minutes tohours exposures tomany few after etc solvent orsoaps, highconcentrationNormally oforganic alteration ofthe skinepidermis Non-immunologic: Physical &chemical Everyone ICD © MIMS Pediatrics 2020 CONTACT DERMATITIS • Phototherapy ACD Chronic Severe • • • Emollients Dermatitis Chronic • • Wet Dressings Dermatitis Acute/Subacute • • Care Skin • • • Trigger &Eliminate Identify Factors • • • ofinflLocation &ICD forACD factors ammation trigger may suggest Trigger (Cont’d)Determine Factors forACD/ICD © orPUVA chronic inpatients ACD UVB w/severe used mayNarrow-band be Avoid orfragrances w/highwater content, products preservatives - Eg petrolatum, liquid paraffi- glycerine, etc n, mineral oils, Patient preference &treatment formula used determine will area anocclusive layerProvide infl over fi &decrease skin,reduce evaporation amed ssuring frequently, applied Should be contact after w/water orirritants especially cooling evaporated gentle w/ exudates by lesions of weeping debridement, healing & debris removal & speeds symptoms Relieves Apply inAlacetate toaff orsalinesolution absorbent soaked material dressings daily times several areas ected Use appropriate creams barrier tobath added symptoms may relieve also Oatmeal products - Wash aff water usingmildsoap &lukewarm areas ected clothing gloves, protective eg protection When personal allergen use avoided, be cannot Avoid habitual lip-licking - offeet ifw/excessive orwater exposure sweating offeet ventilation drying good ®ular Advocate - Avoid compulsive &excessive handwashing - Eg diapers w/super-absorbent frequent ofdisposable diaper changes &use material - PatientICD: shouldavoid contact prolonged w/irritants where the allergen safereplacements isfound&discuss Review - PatientACD: shouldavoid allergens completely &allcross-reactants nailpolish) lipstick, (face make-up, Cosmetics Possible trigger factors: - Eg face mouthwash toothpaste, excessive thumb drooling, sucking, licking/chewing, Lip Possible trigger factors: - mouth Eg lips, etc earrings, metal spectacles, medication, topical hairdyes, Shampoo, Possible trigger factors: - &ears Eg scalp Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing A NON-PHARMACOLOGICAL THERAPY Contact Dermatitis(4of12) 2 DIAGNOSIS (CONT’D)
B56 MIMS © MIMS Pediatrics 2020 CONTACT DERMATITIS 1 Various products are available. Please see prescribing information forspecifiVarious prescribing see are available. Please products c formulations inthe latest MIMS. • Others • (Oral) Antihistamines • • • (Topical/Oral) Corticosteroids ACD • Others • (Oral) Antihistamines • • • (Topical)Corticosteroids ICD • Antibiotics help the itwill patient antihistamine through Ifsedating isused, the tosleep night - Eff ects - - Oral corticosteroids Potent forpersistent dermatitis required may orchronic be dermatitis products - are usuallysuffi Moderately potent products - cient foracutedermatitis 1st-line agents lesions forisolated - - Topical corticosteroids production lymphocyte Anti-inflActions: &immunosuppressing effammatory &stopping the ofcytokines production decreasing by ects - May be needed in cases of secondary infection ofsecondary incases needed May be - Antibiotics help the itwill patient antihistamine through Ifsedating isused, the tosleep night - Eff ects Potent forpersistent dermatitis required may orchronic be dermatitis products are usuallysuffiModerately potent products cient foracutedermatitis 1st-line agents lesions forisolated (Psoralen plusUVA sideeff less (PUVA) which has UVB ornarrowband ects) &phototherapy Other treatments considered being forsteroid-resistant Azathioprine, include Cyclosporin, ACD infection w/secondary associated incases needed May be - Eff ects: that topersist symptoms cause inpatientsRecommended whohave >20-30%oftheir BSAaff toallergens orexposure ACD systemic ected, Eff ects: : Help pruritus torelieve : Help pruritus torelieve Usually eff ofACD cases formost ective Rapid symptomatic relief ofACD 1 1 © (topical/oral) (topical/oral) Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing B PHARMACOLOGICAL THERAPY Contact Dermatitis(5of12)
B57 MIMS © MIMS Pediatrics 2020 CONTACT DERMATITIS Diphenhydramine Dexchlorpheniramine Cyproheptadine Clemastine Chlorpheniramine Carbinoxamine 0.4-1 mg/kg/day PO ≤3yr: Brompheniramine Azatadine First Generation All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not ANTIHISTAMINES -ORAL &ANTIALLERGICS Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing 12.5-25 mg PO 4-6hrly 12.5-25mgPO 6-12 yr: 4-6hrly 6.25PO 2-<6 yr: 6mg/day dose: Max 4-6hrly 1mgPO 6-12 yr: 3mg/day dose: Max 4-6hrly 0.5mgPO 2-5 yr: 16mg/day dose: Max 8-12hrly 4mgPO 7-14 yr: 12mg/day dose: Max 8-12hrly 2mgPO 2-6 yr: 12hrly 0.5-1mgPO 6-12 yr: 12hrly 0.5mgPO 3-6 yr: 12hrly 0.25-0.5mgPO 1-3 yr: 12hrly 4mgPO 6-11 yr: Extended-release: 12mg/day dose: Max 4-6hrly 2mgPO 6-12 yr: 6mg/day dose: Max 4-6hrly 1mgPO 2-5 yr: 12hrly 1mgPO 1-2 yr: Regular-release: 6-8hrly 1-2 mgPO 6-8hrly 2-4mgPO 6-12 yr: 6mg/day dose: Max 6-8hrly 1-2mgPO 3-6 yr: 6hrly divided 12hrly 0.5-1mgPO 6-12 yr: Contact Dermatitis(6of12) Dosage Guidelines Dosage
B58 MIMS • Instructions Special • • • • Reactions Adverse impairment epilepsy, renal impairment orhepatic retention, closure urinary glaucoma, Use w/caution inpatients w/angle reactions hypersensitivity arrhythmias, Palpitations, pain epigastric diarrhea, retention, constipation &GIrefl N/V,ux, urinary vision, blurred secretions, mouth, thickened tract resp dry impairment, psychomotor Headache, continued administration effSedative after tend todecrease ects have stimulation paradoxical incoordination. May dizziness, lassitude, including drowsiness, depression, CNS Remarks © MIMS Pediatrics 2020 CONTACT DERMATITIS Loratadine Levocetirizine Fexofenadine Ebastine Desloratadine Cetirizine Generation Second Promethazine PO wt/day 5ml/10kgbody Pheniramine Oxatomide Mequitazine napadisylate Mebhydrolin Hydroxyzine (Cont’d)First Generation Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © ANTIHISTAMINES -ORAL(CONT’D) &ANTIALLERGICS 5 mg PO 24hrly 5mgPO <30 kg: 24hrly 10mgPO >30 kg: 2-12 yr: 5mg/day dose: Max 24hrly 5mgPO >12 yr: 24hrly 5mgPO 6 yr: 2.5mg/day dose: Max 24hrly 2.5mgPO 6-11 yr: 12hrly 30mgPO 6-11 yr: 24hrly 5mgPO >6 yr: 24hrly 2.5mgPO 6-11 yr: 24hrly 1.25mgPO 2-5 yr: 12hrly 24hrly or5mgPO 10mgPO 6-12 yr: 12hrly 24hrly or2.5mgPO 5mgPO 2-6 yr: 12hrly 2.5mgPO 1-2 yr: 24hrly 2.5mgPO 6 mth-1yr: 25mg/day dose: Max 12 hrly 24hrly or5-10mgPO 10-25mgPO 5-10 yr: 12hrly or 5mgPO 5-15mg/day PO 2-5 yr: 3mg/kg/day dose: Max 8hrly 45 mgPO 8-12hrly or(tab) 15-30mgPO (syrup) >10 yr: 8hrly 22.5mgPO 5-10 yr: 12hrly 0.5-1mg/kgPO dose: Optimal 12hrly 0.5mg/kgPO dose: Initial doses individed 100-300mg/day PO >10 yr: doses individed 100-200mg/day PO 5-10 yr: doses individed 50-150mg/day PO 2-5 yr: doses individed 50-100mg/day PO <2 yr: doses 100mg/day individed dose: Max doses 15-25mg/day individed dose: Initial >6 yr: doses 50mg/day individed dose: Max doses 5-15mg/day individed dose: Initial 6 mth-6yr: Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Contact Dermatitis(7of12) Dosage Guidelines Dosage
B59 MIMS • Instructions Special • • Reactions Adverse • Instructions Special • • • • Reactions Adverse epilepsy hepatic orrenal impairment, Use w/ caution inpatients w/ reactions hypersensitivity arrhythmias, Palpitations, antihistamines than the 1stgeneration impairmentpsychomotor & sedation less Cause impairment renal impairment orhepatic retention, epilepsy, urinary angle closure glaucoma, Use w/caution inpatients w/ reactions hypersensitivity arrhythmias, Palpitations, pain epigastric diarrhea, constipation &GIrefl N/V,ux, retention, urinary vision, blurred secretions, thickened tract resp mouth, impairment, dry psychomotor Headache, administration continued after decrease effSedative tend to ects stimulation May have paradoxical incoordination. dizziness, lassitude, drowsiness, including depression, CNS Remarks © MIMS Pediatrics 2020 CONTACT DERMATITIS 1 Combination the w/other forspecifi latest MIMS emollients see are available. Please c formulations. Betamethasone Dexamethasone fl extr) ower recutita Chamomilla recutita, (Matricaria Chamomile Bar Lotion; Ceramide Methylprednisolone 4-48 mg/day PO 4-48mg/day PO Methylprednisolone Prednisolone Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products Wash Shampoo; Cream; Bath oil; placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed Available Strength
© EMOLLIENTS, CLEANSERS&SKINPROTECTIVES Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not day PO divided 6-12hrly divided day PO 0.0175-0.0125mgbase/kg/ <12 yr: usually preferred Tapering course 2-3wkis over Prednisolone) approximately to5mg equivalent is (0.75 mgDexamethasone 4-5days interval every to0.25-0.5mgPO reduced May be hrly PO6-12 mg 0.75 usually preferred Tapering course 2-3wkis over to5mgPrednisolone) equivalent isapprox(4 mgMethylprednisolone 60mg/day dose: Max 7-10 days 7-10 days then over tapered 24hrly1-2 mg/kg/day x PO Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing CORTICOSTEROID HORMONES-ORAL • • • • • scaling & drying out &drying scaling lipid content, preventing Stabilizes skinmoisture & drying without scalp skin& sensitive Cleanses skin Sensitive dermatitis &skinrashes to moderate atopic Symptomatic relief ofmild skin Dry/sensitive Contact Dermatitis(8of12) Dosage Guidelines Dosage Indication
B60 MIMS • Instructions Special • • Reactions Adverse • Instructions Special • • Reactions Adverse • Instructions Special • • Reactions Adverse • Instructions Special • Reactions Adverse Take w/food Little orno eff onNa&water retentionect Prednisolone See • • • • • • • Take w/food Little orno eff onNa&water retentionect Prednisolone See Take w/food likely Na&water retention tocause Less Prednisolone See Take w/food painorweakness imbalances, electrolyte impaired woundhealing, infection, to susceptibility increased osteoporosis, insuffi adrenocortical wasting, ciency, muscle cataracts, hypertension, gain, Wt long-term: Ifadministered Gastritis. then rinse offthen rinse thoroughly Wash: skin/hair wet allover Massage ApplyCream: toaff area ected water w/lukewarm rinse whole body, gently rub for5minthen Apply Oil: Bath 10-20mLdirectly to soap substitute Use as liquid cleanser Use as Bath: Apply 8-12hrly &/or fortreatment: Moisturizer soap substitute Use as Remarks Remarks 1 © MIMS Pediatrics 2020 CONTACT DERMATITIS 1 Combination the w/other forspecifi latest MIMS emollients see are available. Please c formulations. paraffi n Liquid soap Liquid acid Lactic (Glycerol) Glycerin Cream Dimeticone 2-5%Oint, Dexpanthenol Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All EMOLLIENTS, CLEANSERS&SKINPROTECTIVES Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products Lotion Topical gel gel; 70% 70% Shower Emollient; 63.4% 6% Cream; 85% Bath oil; 7.5% Bar; 15% Wash Soap; 10%, Soln Cream, placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed Available © Strength Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing • • • • • • • • • (pruritus hiemalis) (pruritus winter itch psoriasis, geriatric therapy, chronic eczema, w/ dermatitis, skinassociated dry xerosis, Treatment forichthyosis, & chafing atopic dermatitis pruritus, senile skin,xerosis, dry Emollient for moisturizer infant hygiene Diaper rash, & seborrhea mycosis, intertrigo pruritus, eczema, dermatitis, dermatitis, seborrheic Antiseptic intopical infant/elderly skin skin, allergic dermatitis, sun-damaged skin areas, soap-intolerant hiemalis, ichthyosis, pruritus atopic orinfantile eczema, xerosis, skinareas, sensitive treatmentCleansing fordry smoothness flexibility, & softness moisture &enhance skin skin Helps increase skin damaged & dry very protect & repair Helps relieve, skin Dry/damaged Diaper rash Contact Dermatitis(9of12) Dosage Guidelines Indication
B61 MIMS • • • • • • • • • • massage gently.massage off Rinse whileskiniswet. area & en rub Apply tothe wholeaffShower: ected forbath used be also can area; WetEmollient: inaff skin&rub ected inwellrub ApplyCream: onto aff & area ected Pat dry thin film ofoiltoremain onthe skin. excessively rinsing from a toallow affwater &cleanse Refrain area. ected WorkBar: lather uparich w/alittle water. for10-20min Soak to8-inch bath Add 1-3capful Bath: Apply onto aff 12hrly area ected asoap substitute Use as required as often Use as needed at night oras shower after ontoMassage skininthe & morning Apply onto aff needed as area ected 1 (CONT’D) Remarks © MIMS Pediatrics 2020 CONTACT DERMATITIS 2 1 Combination w/ other antiseptics & disinfectants are available. Please see the forspecifi latest MIMS see are available.Combination w/other &disinfectants Please antiseptics c formulations. Combination the w/other forspecifi latest MIMS emollients see are available. Please c formulations. ermd .%CemApply toaff area ected 0.5%Cream Cetrimide icoie7.5%,10%, Lotion oxide Zinc Vitamin E Cream Oint; Vitamin A Urea isomerate Saccharide (Mineral oil) Paraffi n Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All EMOLLIENTS, CLEANSERS&SKINPROTECTIVES Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products powd TopicalOint; 200 mg/g 40%, Cream; 310 mg/g 32%, Cream 20% 5%, 10%, Lotion Cream; Shower Gel; Emollient; Cream; Bar; placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed Available Available © Strength Strength Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing SKIN ANTISEPTICS &DISINFECTANTSSKIN ANTISEPTICS 8-12 hrly • • • • • • • • Contact Dermatitis(10of12) eczema &slighteczema excoriation in &protects Soothes burns wounds& non-infected skin irritations, ofminor healing Promotes contactdirect w/the skin coming from intowetness preventing by diaper rash Prevention &treatment of skin Dry skin wounds &dry small sunburn, burns, chafiDiaper rash, minor ng, pruritus) dermatitis, contactxerosis, irritant skinconditions (eg dry hyperkeratotic orexcessive Emollient for ichthyosis psoriasis, eczema, dermatitis, tochronic skin secondary Symptomatic relief ofdry skin sensitive Itchy, dry, irritated, Dosage Guidelines Dosage Indication
B62 MIMS • • Instructions Special • Reactions Adverse Avoid cavities inbody use Avoid contact w/eyes sensitization occasional Skin irritation, • • • • • • • especially at bedtime at especially Apply atInfants: diaper each change Apply needed as Apply 8-12hrly aff required 8-12hrly area &as ected Apply into &rub the sparingly shower after especially needed Apply as often 12hrly oras onto skin wet Add tobath water orrub Emollient: the skin of essentialoilsfrom loss counteract to washing immediately after It benefi isparticularly cial ifapplied required. as often inwell.rub Use as ApplyCream: tothe aff & area ected 2 1 Remarks (CONT’D) Remarks © MIMS Pediatrics 2020 CONTACT DERMATITIS 1 Topical information forspecifi prescribing corticosteroids see are Please available incombination antibiotics. w/topical c formulations in the latest MIMS. propionate Clobetasol Very Potent propionate Fluticasone caproate Fluocortolone 0.05%cream, Fluocortolone/ Fluocinonide acetonide Fluclorolone valerate Difl ucortolone ( Desoximetasone dipropionate Beclometasone dipropionate Betamethasone acetonide Fluocinolone valerate Betamethasone 0.1%cream, Amcinonide Potent Desoxymetasone) Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed application scalp cream,gel, oint, 0.05% ©0.005% oint 0.05% cream cream 0.25%/0.25% lotion, oint 0.2% cream gel, oint 0.025% cream, oint 0.01% cream, Apply 12hrly 0.025% cream Apply 12hrly for 0.3% fatty oint fatty oint oint, 0.1% cream, cream, oint 0.05% gel0.25% lotion, oint,soln Apply 8-24hrly 0.1% cream, 0.06% cream 0.05% cream 0.025% cream Apply 12hrly 0.025% cream soln oint, 0.064% cream, soln oint, 0.05% cream, lotion, oint Available Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Strength Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing TOPICAL CORTICOSTEROIDS Contact Dermatitis(11of12) Dosage Guidelines Apply 12-24hrly Apply 12hrly Apply 12-24hrly Apply 8-12hrly Apply 8-24hrly up to2wk for upto4wk Apply 12-24hrly Apply 12hrly Apply 8-24hrly Apply 8-12hrly Apply 12hrly Apply 8-12hrly Dosage
B63 MIMS • • • • Instructions Special • • • • Reactions Adverse • • • • Application s - t c ff e e Mildly potent agents rarely side will cause - areas) (except onface orintertriginous ifused rarely sideeff cause for<3mth ifused ects Moderately potent &potent agents will <1yr infants Very in potent agents used shouldnotbe areas face &intertriginous Mildly potent preparations are for preferred Tachyphylaxis occur can - Absorption is more likely when used ismore likely when Absorption used - thin by &/orraw isincreased Absorption - &Cushing’shypertension syndrome retardation, growth suppression, pituitary-adrenal-axis cause skin can Systemic eff through the Absorption ects: atrophica &striae telangiectasia irreversible reversible, may be of application, hypopigmentation which acneat contact site infection, dermatitis, treatment, ofunderlying worsening stopping after restored or may notbe effLocal ects: inningofskinwhich may chance reactions ofadverse emore potent the agent, the more improves the preparations condition as potency w/weaker 3wk)following for 1-2wk(max potent agents is ofvery use Recommended cover 2xthe offl size at adulthand (approx 500mg)issuffi1 FTU cient to which istip ofadultindexfinger to1stcrease fi by measured be can nger tipunit(FTU) tube from ofcream/ointLength squeezed or solesoffeet administration maybenecessaryforpalms for mostagents.Morefrequent Twice dailyapplicationsarerecommended especially iflarge are treated areas especially continuousto long-term therapy Intermittent therapy isusually preferable to long-term continuousto long-term therapy Intermittent therapy isusuallypreferable over very large &inchildren areas very over orocclusion areas skin, intertriginous 1 Remarks © MIMS Pediatrics 2020 CONTACT DERMATITIS 1 in the latest MIMS. Topical information forspecifi prescribing corticosteroids see are Please available incombination antibiotics. w/topical c formulations Halometasone 0.05% cream, 0.05%cream, Halometasone Potent (Cont’d) rdiooe05 ra Apply 8-24hrly 0.5%cream Prednisolone 0.1%cream, Hydrocortisone PotentMildly acetonide Apply 8-12hrly Triamcinolone butyrate Hydrocortisone 0.02%oint acetate Fluprednidene Flumetasone Desonide butyrate Apply 12-24hrly Clobetasone dipropionate Alclometasone 0.25%cream PotentModerately Prednicarbate furoate Mometasone aceponate Methylprednisolone aceponate Hydrocortisone Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed oint ©oint lotion, cream, lotion, oint 2.5% cream 0.5% cream 0.02% cream lotion0.2% scalp lotion, oint, 0.1% cream, soln oint, 0.1% cream, 0.1%oint% oint, 0.05 0.1% cream, lotion, oint 0.05% cream, oint 0.05% cream, oint 0.05% cream, oint gel,oint, lotion, fatty0.1% cream, Apply 24hrly Apply 12-24hrly oint 0.1% cream, 0.127% cream Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Available Strength Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing TOPICAL CORTICOSTEROIDS Please see the end of this section for the reference list. reference the for section this of end the see Please Contact Dermatitis(12of12) Dosage Guidelines Apply 12-24hrly Apply 8-12hrly Apply 6-12hrly Apply 12hrly Apply 12-24hrly Apply 8-12hrly Apply 12-24hrly Apply 8-12hrly Apply 24hrly Dosage
B64 MIMS • • • • Instructions Special • • • • Reactions Adverse • • • • Application Intermittent therapy isusuallypreferable - eff ects Mildly potent agents rarely side will cause Intermittent therapy isusuallypreferable - areas) onface orintertriginous if used cause sideeff for<3mth (except ifused ects Moderately potent&agentswillrarely <1yr infants Very in potent agents used shouldnot be areas for face &intertriginous Mildly potent preparations are preferred Tachyphylaxis canoccur Absorptionismore likelywhenused - Absorptionisincreased bythin&/orraw - hypertension &Cushing’ssyndrome suppression, growthretardation, skin cancausepituitary-adrenal-axis Systemic effects: Absorptionthroughthe telangiectasia &striaeatrophica may bereversible,irreversible of application,hypopigmentationwhich infection, contactdermatitis,acneatsite treatment, worseningofunderlying or maynotberestoredafterstopping Local effects: inningofskinwhichmay chance ofadversereactions emore potenttheagent,more improves the preparations condition as potency w/weaker 3wk)following for 1-2wk(max potent agents is ofvery use Recommended cover 2xthe offl size at adulthand (approx 500mg)issuffi1 FTU cient to crease which is tip ofadultindexfinger to1st fi by measured be can nger tipunit(FTU) tube from ofcream/ointLength squeezed offeet or soles forpalms administration necessary may be More frequent agents. for most Twice dailyapplications are recommended 1 (CONT’D) especially iflarge are treated areas especially continuousto long-term therapy to long-term continuousto long-term therapy over verylargeareas&inchildren skin, intertriginousareasorocclusion Remarks © MIMS Pediatrics 2020