Treatment of different age groups
ChildrenEspecially in newborns, it has to considered that topically applied drugs may cause intoxication due to the different body volume/body surface proportion. Topical treatment modalities comprise
- cooling lotions, menthol, camphor
- mild to moderately potent topical corticosteroids (in severe cases, potent corticosteroids may be used even for infants under dermatological surveillance)
- antibiotics and antiseptics such as erythromycin and fusidin acid.
- topical antimycotics (they can be used without any restrictions)
- topical immunomodulators such as tacrolimus and pimecrolimus (indicated for children older than 2 years)
- Capsaicin (not indicated for children under 12 years but may be applied in younger children without any severe side effects as an off-label use (personal experience).
- Urea containing preparations (not recommended for children younger than 6 years, as they may cause stinging and burning)
- Tar preparations like coal tar (not indicated for infants because of possible toxic side-effects due to systemic absorption). They may be used in older children for a duration up to 4 weeks; when supervised by a dermatologist this time period may be prolonged. As coal tars can contain cancerogenic substances, they should generally not be applied in infants and young children. Bituminous tar does not bear this risk and may therefore be applied in paediatric patients.
Salicylic acid is not recommended for topical therapy in infants and young children because of possible toxic systemic side-effects when applied on larger body areas.
The dosages of systemic drugs need to be adapted in recognition of age and body weight. Antibiotics such as penicillin, amoxicillin, 1st and 2nd generation cephalosporines, erythromycin, azithromycin and griseofulvin (antimycotic) may be given in children. Prednisolone is the safest oral corticosteroid in children. Antihistamine administration must be dose-adapted and occur in recognition of the age of indication: dimenthidenmaleat (> 1 year), cetirizine and desloratadine (> 2 years), hydroxycine and levocetirizine (> 6 years).
The following systemic treatment modalities are not indicated in children: cyclosporine A (> 18 years), minocycline (> 8 years), ketoconazole and itraconazole (> 18 years), UV-therapy (> 10 years) and PUVA therapy (> 18 years). Clinical studies have shown safety of cyclosporine treatment in children without any severe side effects but this is to be considered as an off-label use. According to clinical studies, systemic ketoconazole and itraconazole may be applied as off-label use in children younger than 18 years when griseofulvin is not effective. In general, UV phototherapy should be performed with caution in children due to possible longterm photo damage of the skin.