Contact dermatitis is an inflammation of the skin caused by irritants or allergic reactions. In the pediatric population, 20% of all cases of contact dermatitis are attributed to T-cell -mediated hypersensitivity reactions. The condition can be categorized as irritant or allergic.
Irritant contact dermatitis is caused by non–immune-modulated irritation of the skin by a substance, leading to skin changes. Common irritants include:
- Soaps and detergents
- Diaper dermatitis
- Frequent wet-to-dry episodes (lip-licking, thumb-sucking)
Allergic contact dermatitis is a delayed hypersensitivity reaction in which a foreign substance comes into contact with the skin; skin changes will occur with reexposure. Common allergens:
- Poison ivy, oak, and sumac
- Shoe leather
- Cosmetics and topical medications
- Nickel often found in jewelry and clothes fasteners
- Pruritus, erythema, and vesiculation
- Often well demarcated borders
- Edema, oozing, and scaling
- Chronic contact dermatitis may have lichenification of the skin and with pronounced scaling. There may also be fissuring and secondary infection.
- Thorough history and physical examination.
- Type of onset and where the rash began
- Patch testing for allergic contact dermatitis. Allergens are applied to the skin for 48 hours and reaction observed. Sensitivity and specificity are about 70%. Kits with common allergens are available.
- Removal of substance and washing well after contact. Allergen avoidance is essential in treatment.
- Topical corticosteroids like triamcinolone 0.1% (Kenalog, Aristocort) or clobetasol 0.05% (Temovate).
- Severe cases or cases covering over 10% of body area may require systemic corticosteroids.
- Burrow's solution, oral antihistamines and Calamine lotion may give symptomatic relief.
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