Contact Dermatitis Drug Summary

Drug	Dosage		Remarks
	Children	Adult
First Generation
Azatadine	6-12 years old: 0.5-1 mg PO 12 hourly	1-2 mg PO 12 hourly	Adverse Reactions Most common: CNS effects (drowsiness, lassitude, dizziness, incoordination, paradoxical stimulation) Other common: CNS effects (headache, psychomotor impairment); Antimuscarinic effects (dry mouth, viscous secretions, urinary retention, blurred vision) Occasionally can cause GI effects (nausea/vomiting, diarrhea, epigastric pain, anorexia or increased appetite); CV effects (palpitations, arrhythmias, rarely hazardous ventricular arrhythmias); Hypersensitivity reactions (rashes, angioedema, anaphylaxis); Other effects (convulsion, sweating, myalgia, tremor, hypotension) Promethazine may sometimes cause photosensitivity or jaundice Special Instructions Avoid use in patients who need mental alertness (eg driving or using machineries) and with alcohol intake Use with caution in patients with angle-closure glaucoma, urinary retention, prostatic hyperplasia, epilepsy, renal or hepatic impairment - Reduction of dosage may be needed
Brompheniramine	≤3 years old: 0.4-1 mg/kg/day PO divided 6 hourly 3-6 years old: 1-2 mg PO 6-8 hourly Max dose: 6 mg/day 6-12 years old: 2-4 mg PO 6-8 hourly	4-8 mg PO 6-8 hourly Max dose: 24 mg/day
Buclizine	-	25-50 mg/day PO
Carbinoxamine	1-2 mg PO 6-8 hourly	4-8 mg PO 6-8 hourly
Chlorpheniramine	Regular-release: 1-2 years old: 1 mg PO 12 hourly 2-5 years old: 1 mg PO 4-6 hourly Max dose: 6 mg/day 6-12 years old: 2 mg PO 4-6 hourly Max dose: 12 mg/day Extended-release: 6-11 years old: 4 mg PO 12 hourly	Regular-release: 4 mg PO 4-6 hourly Max dose: 24 mg/day Extended-release: 8-12 mg PO 12 hourly
Clemastine (base)	1-3 years old: 0.25-0.5 mg PO 12 hourly 3-6 years old: 0.5 mg PO 12 hourly 6-12 years old: 0.5-1 mg PO 12 hourly	1 mg PO 12 hourly Max dose: 6 mg/day
Cyproheptadine	2-6 years old: 2 mg PO 8-12 hourly Max dose: 12 mg/day 7-14 years old: 4 mg PO 8-12 hourly Max dose: 16 mg/day	4 mg PO 8 hourly May increase as necessary up to Max dose: 32 mg/day
Dexchlorpheniramine	2-6 years old: 0.5 mg PO 4-6 hourly Max dose: 3 mg/day 6-12 years old: 1 mg PO 4-6 hourly Max dose: 6 mg/day	Regular-release: 2 mg PO 4-6 hourly Max dose: 12 mg/day Extended-release: 6 mg PO 12 hourly
Dimethindene	-	Regular-release: 1-2 mg PO 8 hourly Extended-release: 2.5 mg PO 12 hourly or 4 mg PO 24 hourly
Diphenhydramine (Dimenhydrinate)	2-<6 years old: 6.25 mg PO 4-6 hourly 6-12 years old: 12.5-25 mg PO 4-6 hourly	25-50 mg PO 6-8 hourly Max dose: 300 mg/day
Homochlorcyclizine	-	10-20 mg PO 8 hourly
Hydroxyzine	6 months-6 years old: Initial dose: 5-15 mg/day in divided doses Max dose: 50 mg/day in divided doses >6 years old: Initial dose: 15-25 mg/day in divided doses Max dose: 100 mg/day in divided doses	25 mg PO 24 hourly at night May increase to 25 mg PO 6-8 hourly
Mebhydrolin napadisylate	<2 years old: 50-100 mg/day PO in divided doses 2-5 years old: 50-150 mg/day PO in divided doses 5-10 years old: 100-200 mg/day PO in divided doses >10 years old: 100-300 mg/day PO in divided doses	100-300 mg/day PO
Mequitazine	5 mL/10 kg body wt/day PO	5 mg PO 12 hourly
Oxatomide	Initial dose: 0.5 mg/kg PO 12 hourly Optimal dose: 0.5-1 mg/kg PO 12 hourly	30 mg PO 12 hourly
Pheniramine	5-10 years old: 22.5 mg PO 8 hourly >10 years old: (syrup) 15-30 mg PO 8-12 hourly or (tab) 45 mg PO 8 hourly Max dose: 3 mg/kg/day	45 mg PO 8 hourly Max dose: 3 mg/kg/day
Piprinhydrinate	-	3-6 mg PO 8 hourly
Promethazine	2-5 years old: 5-15 mg/day PO or 5 mg PO 12 hourly >5-10 years old: 10-25 mg PO 24 hourly or 5-10 mg PO 12 hourly Max dose: 25 mg/day	Initial dose: 10 mg PO 12 hourly or 25 mg PO 24 hourly at night Max dose: 20 mg PO 8 hourly
Second Generation
Acrivastine	-	8 mg PO 8 hourly	Adverse Reactions Cause little or no drowsiness and antimuscarinic effect as compared to first generation antihistamines - Cetirizine may cause higher incidence of drowsiness as compared with other second generation antihistamines Special Instructions Use with caution in patients who need mental alertness (eg driving or using machineries), may rarely affect performance of skilled task Use with caution in patients with hepatic or renal impairment, epilepsy and in the elderly
Cetirizine	6 months-1 year old: 2.5 mg PO 24 hourly 1-2 years old: 2.5 mg PO 12 hourly 2-6 years old: 5 mg PO 24 hourly or 2.5 mg PO 12 hourly 6-12 years old: 10 mg PO 24 hourly or 5 mg PO 12 hourly	10 mg PO 24 hourly
Desloratadine	2-5 years old: 1.25 mg PO 24 hourly 6-11 years old: 2.5 mg PO 24 hourly	5 mg PO 24 hourly
Ebastine	>6 years old: 5 mg PO 24 hourly	10-20 mg PO 24 hourly
Fexofenadine	6 months-<2 years old: 15 mg PO 12 hourly 2-11 years old: 30 mg PO 12 hourly	Regular-release: 60 mg PO 12 hourly Extended-release: 120-180 mg PO 24 hourly
Levocetirizine	6 months-5 years old: 1.25 mg PO 24 hourly 6-11 years old: 2.5 mg PO 24 hourly Max dose: 2.5 mg/day ≥12 years old: 5 mg PO 24 hourly Max dose: 5 mg/day	5 mg PO 24 hourly Max dose: 5 mg/day
Loratadine	2-12 years old: >30 kg: 10 mg PO 24 hourly ≤30 kg: 5 mg PO 24 hourly	10 mg PO 24 hourly

Drug	Dosage	Remarks
Betamethasone	Children ≤12 years old: 0.0175-0.0125 mg base/kg/day PO divided every 6-12 hours Adult: 0.5-5 mg/day PO in divided doses (0.6-0.75 mg Betamethasone is approximately equivalent to 5 mg Prednisolone) Tapering course over 2-3 weeks is usually preferred	Adverse Reactions See Prednisolone below Little or no effect on Na and water retention Special Instructions Take with food
Dexamethasone	0.75-9 mg PO 6-12 hourly May be reduced to 0.25-0.5 mg PO every 4-5 days interval (0.75 mg Dexamethasone is approximately equivalent to 5 mg Prednisolone) Tapering course over 2-3 weeks is usually preferred
Methylprednisolone	4-48 mg/day PO (4 mg Methylprednisolone is approximately equivalent to 5 mg Prednisolone) Tapering course over 2-3 weeks is usually preferred	Adverse Reactions See Prednisolone below Less likely to cause Na and water retention Special Instructions Take with food
Prednisolone	Children: 1-2 mg/kg/day PO 24 hourly x 7-10 days then tapered over 7-10 days Max dose: 60 mg/day Adult: 5-60 mg/day PO divided or as a single dose Max dose: 250 mg/day Tapering course over 2-3 weeks is usually preferred	Adverse Reactions Gastritis. If administered long-term: Weight gain, hypertension, cataracts, adrenocortical insufficiency, osteoporosis, muscle wasting, pain or weakness, increased susceptibility to infection, impaired wound healing, electrolyte imbalances Special Instructions Take with food

Drug	Available Strength	Dosage	Remarks
Very Potent			Application Twice daily applications are recommended for most agents. More frequent administration may be necessary for palms or soles of feet Length of cream/ointment squeezed from tube can be measured by finger tip unit (FTU) which is tip of adult index finger to first crease 1 FTU (approximately 500 mg) is sufficient to cover 2x the size of flat adult hand Recommended use of very potent agents is for 1-2 weeks (max 3 weeks) following with weaker potency preparations as the condition improves Adverse Reactions The more potent the agent, the more chance of adverse reactions Local effects: Thinning of skin which may be restored after stopping treatment, worsening of underlying infection, contact dermatitis, acne at site of application, hypopigmentation which may be reversible, irreversible telangiectasia and striae atrophica Systemic effects: Absorption through the skin can cause pituitary-adrenal-axis suppression, growth retardation, hypertension and Cushing’s syndrome Absorption is increased by thin and/or raw skin, intertriginous areas or occlusion Absorption is more likely when used over very large areas and in children Tachyphylaxis can occur Special Instructions Low potency preparations are preferred for face and intertriginous areas Very potent agents should not be used in infants <1 year Moderate and high potency agents will rarely cause side effects if used for <3 months (except if used on face or intertriginous areas) Intermittent therapy is usually preferable to long-term continuous therapy Mildly potent agents will rarely cause side effects Intermittent therapy is usually preferable to long-term continuous therapy especially if large areas are treated
Clobetasol propionate	0.05% cream, gel, lotion, ointment, scalp application	Apply 12-24 hourly
Halcinonide	0.1% cream, ointment, solution	Apply 8-12 hourly
Potent
Amcinonide	0.1% cream	Apply 8-12 hourly
Beclometasone dipropionate	0.025% cream	Apply 12 hourly
Betamethasone dipropionate	0.05% cream, ointment, solution, 0.064% cream, ointment, solution	Apply 12-24 hourly
Betamethasone valerate	0.025% cream, 0.05% cream, 0.06% cream	Apply 8-12 hourly
	0.1% cream, lotion, ointment, solution	Apply 8-24 hourly
Desoximetasone (Desoxymetasone)	0.05% gel 0.25% cream, ointment	Apply 12 hourly
Diflucortolone valerate	0.3% fatty ointment	Apply 12 hourly for up to 2 weeks
	0.1% cream, ointment, fatty ointment	Apply 12-24 hourly for up to 4 weeks
Fluclorolone acetonide	0.025% cream	Apply 12 hourly
Fluocinolone acetonide	0.025% cream, gel, ointment, 0.03% ointment	Apply 8-24 hourly
	0.2% cream	Apply 8-12 hourly
	0.005% cream 0.01% cream, ointment 0.0125% cream	Apply 8-24 hourly
Fluocinonide	0.05% cream, gel, ointment, solution	Apply 8-12 hourly
Fluocortolone/Fluocortolone caproate	0.25%/0.25% cream, ointment	Apply 12-24 hourly
Fluocortolone pivalate/Fluocortolone caproate	0.25%/0.25% ointment
Fluticasone propionate	0.05% cream 0.005% ointment	Apply 12 hourly	Application Twice daily applications are recommended for most agents. More frequent administration may be necessary for palms or soles of feet Length of cream/ointment squeezed from tube can be measured by FTU which is tip of adult index finger to first crease 1 FTU (approximately 500 mg) is sufficient to cover 2x the size of flat adult hand Recommended use of very potent agents is for 1-2 weeks (max 3 weeks) following with weaker potency preparations as the condition improves Adverse Reactions The more potent the agent, the more chance of adverse reactions Local effects: Thinning of skin which may be restored after stopping treatment, worsening of underlying infection, contact dermatitis, acne at site of application, hypopigmentation which may be reversible, irreversible telangiectasia and striae atrophicae Systemic effects: Absorption through the skin can cause pituitary-adrenal-axis suppression, growth retardation, hypertension and Cushing’s syndrome Absorption is increased by thin and/or raw skin, intertriginous areas or occlusion Absorption is more likely when used over very large areas and in children Tachyphylaxis can occur Special Instructions Low potency preparations are preferred for face and intertriginous areas Very potent agents should not be used in infants <1 yr Moderate and high potency agents will rarely cause side effects if used for <3 months (except if used on face or intertriginous areas) Intermittent therapy is usually preferable to long-term continuous therapy Mildly potent agents will rarely cause side effects Intermittent therapy is usually preferable to long-term continuous therapy especially if large
Halometasone	0.05% cream, ointment	Apply 12-24 hourly
Hydrocortisone aceponate	0.127% cream	Apply 12-24 hourly
Methylprednisolone aceponate	0.1% cream, ointment	Apply 24 hourly for <12 weeks
Mometasone furoate	0.1% cream, fatty ointment, gel, lotion, ointment	Apply 24 hourly
Prednicarbate	0.25% cream, 0.1% ointment	Apply 12-24 hourly
Moderately Potent
Alclometasone dipropionate	0.05% cream, ointment	Apply 8-12 hourly
Clobetasone butyrate	0.05% cream, ointment	Apply 12-24 hourly
Desonide	0.05% cream, lotion, ointment	Apply 8-12 hourly
Flumetasone	0.02% ointment	Apply 8-12 hourly
Fluprednidene acetate	0.1% cream, 0.05% ointment, 0.1% ointment	Apply 12-24 hourly
Hydrocortisone butyrate	0.1% cream, ointment, solution	Apply 12 hourly
Triamcinolone acetonide	0.1% cream, lotion, ointment 0.2% cream 0.02% cream	Apply 6-12 hourly
Mildly Potent
Hydrocortisone	0.5% cream 1% cream, gel, lotion 2.5% lotion	Apply 8-12 hourly
Hydrocortisone acetate	1% cream, ointment 2.5% cream	Apply 8-12 hourly
*Topical corticosteroids are available in combination with topical antibiotics. Please see the latest MIMS for specific formulations and prescribing information.

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.