Treatment of Pediatric Rashes

Atopic Dermatitis (Eczema)

• The American Academy of Dermatology recommends regular use of emollients for all patients with atopic dermatitis, providing both short and long-term steroid-sparing effects 1, 3
• Emollients should be applied immediately after a 10-15 minute lukewarm bath for maximum benefit 3
• The British Medical Journal suggests avoiding soaps and detergents as they remove natural lipids from the skin; use dispersible creams as soap substitutes instead 4
• Keeping nails short and wearing cotton clothing rather than irritating fabrics like wool is recommended to minimize damage from scratching 4
• Topical corticosteroids (TCS) are the mainstay treatment for flare-ups, using the least potent effective formulation 1, 4
• For children, less potent TCS than those prescribed for adults should be used, especially on sensitive areas (face, neck, skin folds) 1
• Topical calcineurin inhibitors (TCIs) like pimecrolimus 1% cream and tacrolimus ointment (0.03% and 0.1%) are steroid-sparing alternatives for children aged 2 years and above 1, 2
• Proactive therapy with twice-weekly application of TCS or TCIs to previously affected areas helps prevent relapses in moderate to severe cases 1, 2
• Wet-wrap therapy with TCS is an effective short-term second-line treatment for moderate to very severe atopic dermatitis 1
• Oral antihistamines are recommended as adjuvant therapy for reducing pruritus 1
• Topical phosphodiesterase-4 inhibitors have been approved for mild to moderate atopic dermatitis 1
• Long-term application of topical antibiotics is not recommended due to increased risk of resistance and skin sensitization 1
• Topical antihistamines are not recommended due to limited evidence and potential risk of contact dermatitis 1

Psoriasis

• Topical corticosteroids are first-line therapy for localized disease 2
• Vitamin D analogs in combination with corticosteroids are recommended 2
• For facial and genital psoriasis, tacrolimus 0.1% ointment is preferred 2
• Narrowband UVB phototherapy is recommended for moderate to severe plaque and guttate psoriasis in children 5, 2
• Natural sunlight in moderation can be considered when in-office phototherapy isn't feasible 5, 2
• Methotrexate is the most common systemic medication for pediatric psoriasis 5, 2
• Cyclosporine may be used for rapid control of severe disease 2