**8. Treatment**

The cornerstone of treatment of ACD is proper allergen avoidance. Once an allergen is identified, patients must be educated on potential exposures, cross-reacting chemicals, preventive measures, as well as offered suggestions for avoidance. This may be especially difficult in households with small children affected, as the products that are used by the patents and sibling may also need to be considered as sources for allergen exposures.

Emollients can be added after a bath in an effort to retain hydration and restore the barrier function of the skin. Barrier repair also decreases pruritus and reduces visible scaling and dryness. Physical barrier creams may be useful in cases in which the allergen exposure cannot be avoided. Patients should apply the creams before and during the exposure in an effort to decrease absorption (Lee et al., 2009).

Topical corticosteroids are the first-line treatment modality for mild cases of ACD but they are not without risk and can cause multiple cutaneous side effects with extensive and long term use (Militello et al., 2006; Goossens & Morren, 2006; Jacob & Castanedo-Tardan, 2007; Lee et al., 2009). When selecting a topical corticosteroid for treatment, it is important to choose one that the patient is not allergic to in terms of the active ingredient (the steroid component) and inactive ingredients in the vehicle (Lee et al., 2009). As with any topical steroid, the risk of atrophy, teleangiectasias, tachyphylaxis and systemic absorption should be kept in mind, especially in areas of increased sensitivity such as face, groin and flexural area (Militello et al., 2006).

Topical calcineurin inhibitors (TCIs) are another therapeutic option and should be considered when steroid-sparing agents are required. These agents can be used for certain areas, such as the face, axilla and groin, which are more susceptible to steroid-induced atrophy (Lee et al., 2009).

In cases of widespread and severe reactions, Militello et al. (Militello et al., 2006) recommended at least 3 weeks of oral prednisone in combination with topical therapy. Shorter courses often lead to rebound flares of the dermatitis. Systemic corticosteroids are generally started at 1 mg/kg per day (Brasch, 2009). Oral H1-antihistamines are widely used as an adjuvant nonspecific treatment for pruritus in infants and children. They also cause drowsiness that may help with sleeping disturbances from pruritus (Militello et al., 2006; Lee et al., 2009).
