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[Special characteristics of topical treatment in childhood]
1Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München.
Insights
Infant skin differs from adult skin in how it absorbs topical substances, requiring different treatments for skin conditions in children. Careful consideration of these age-related physiological differences is crucial for safe and effective topical therapies.
Area of Science:
- Dermatology
- Pediatrics
- Pharmacology
Context:
- Newborn and infant skin, despite a developed stratum corneum, exhibits distinct cutaneous and systemic metabolism of topical agents compared to adults.
- This difference is attributed to a higher surface area-to-weight ratio in children, leading to greater systemic availability of applied substances.
- Historical incidents highlight risks of toxic reactions and fatalities in infants from certain topical drugs applied at high concentrations or large areas.
Purpose:
- To delineate age-dependent differences in the metabolism and response to topical applications in pediatric skin.
- To compare therapeutic approaches for childhood dermatoses with those for adults, focusing on topical glucocorticosteroids, urea, and dyes in atopic eczema.
- To emphasize the importance of considering physiological variations in newborn and infant skin for appropriate dermatological care.
Summary:
- Infants metabolize topical substances differently than adults due to physiological variations, primarily a higher surface area-to-weight ratio.
- Specific topical treatments, including glucocorticosteroids, urea, and dyes for atopic eczema, require age-adjusted protocols.
- Newer topical formulations, like anesthetic creams for molluscum contagiosum, offer improved therapeutic options for common pediatric skin conditions.
Impact:
- Highlights the need for specialized dermatological treatment strategies in pediatric populations.
- Informs the development of safer and more effective topical medications tailored for infant and child skin.
- Underscores the critical importance of understanding pharmacokinetic and pharmacodynamic differences in pediatric topical drug administration.
Abstract:
Although the barrier function and thickness of the stratum corneum is fully developed in newborns, the infant shows numerous differences in cutaneous and systemic metabolism of topically applied substances in comparison to adults. This discrepancy between children and adults has been explained by the greater systemic availability due to the greater surface area to weight ratio in children. Several topically applied drugs such as hexachlorophene, phenol, salicylic acid and boric acid in high concentration or on large areas have caused toxic reactions and fatalities in infants. Therapeutic approaches to childhood dermatoses differ from these used in adults. These age-dependent differences concerning the topical application of glucocorticosteroids, urea and dyes are described for the treatment of atopic eczema. The development of innovative topical drugs may extend therapeutic options especially in children as shown by a new topical anesthetic cream improving the treatment of mollusca contagiosa, a common childhood problem. Finally, certain physiological differences should be considered in newborn and infant skin care.