Contact Dermatitis

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 dermatitis

Irritant contact dermatitis is caused by non–immune-modulated irritation of the skin by a substance, leading to skin changes. Common irritants include:

  1. Soaps and detergents
  2. Diaper dermatitis
  3. Frequent wet-to-dry episodes (lip-licking, thumb-sucking)

 

Allergic dermatitis

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:

  1. Poison ivy, oak, and sumac
  2. Shoe leather
  3. Cosmetics and topical medications
  4. Nickel often found in jewelry and clothes fasteners

 

Clinical Presentation

  1. Pruritus, erythema, and vesiculation
  2. Often well demarcated borders
  3. Edema, oozing, and scaling
  4. Chronic contact dermatitis may have lichenification of the skin and with pronounced scaling. There may also be fissuring and secondary infection.

 

Diagnosis

  1. Thorough history and physical examination.
  2. Type of onset and where the rash began
  3. 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.

 

Treatment

  1. Removal of substance and washing well after contact.  Allergen avoidance is essential in treatment.
  2. Topical corticosteroids like triamcinolone 0.1% (Kenalog, Aristocort) or clobetasol 0.05% (Temovate).
  3. Severe cases or cases covering over 10% of body area may require systemic corticosteroids.
  4. Burrow's solution, oral antihistamines and Calamine lotion may give symptomatic relief.

 

References

  1. Ustane, RP and Riojas M. Diagnosis and Management of Contact Dermatitis. Am Fam Physician. 2010 Aug 1;82(3):249-255

  2. Adkinson: Middleton’s Allergy: Principles and Practice, 6th ed., Copyright 2003 Mosby, Inc.
  3. Cohen, D. Contact Dermatitis: a Quarter Centery perspective. Journal of the American Academy of Dermatology. 2004; 51(1): S60-3.
  4. Deleo, VA. The effect of race and ethnicity on patch test results. Journal of the American Academy of Dermatology. 2002; 46(2): 107-112Ferri:
  5. Krob, HA. Prevalence and relevance of contact dermatitis allergens: a meta-analysis of 15 years of Published T.R.U.E. Test Data. Journal of the American Academy of Dermatology. 2004; 51 (3): 349-353.
  6. Sanfilippo, A. et al. Common pediatric and adolescent skin conditions. Journal of Pediatric and Adolescent Gynecology. 2003; 16 (5): 269-283.
  7. Shaw, D. et al. Allergic Contact Dermatitis from Tacrolimus. Journal of the American Academy of Dermatology. 2004; 50(6): 962-5.
  8. Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2005 ed., Copyright 2005 Mosby, Inc.

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