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CONTACT DERMATITIS (PEDIATRIC)
Allergic contact dermatitis is an immunologic cell-mediated skin reaction to exposure to antigenic substances.
The lesions initially appear on the cutaneous site of principal exposure then may spread to other more distant sites due to contact or autosensitization. Lesions are typically asymmetrical and unilateral.
Specific signs and symptoms will depend on the duration, location, degree of sensitivity and concentration of allergens. The patch test shows reaction to allergen.
Irritant contact dermatitis is a non-immunologic skin reaction to skin irritants.
It is often localized to areas of thin skin eg eyelids, intertriginous areas.

Diagnosis

Allergic Contact Dermatitis (ACD)

  • An immunologic cell-mediated skin reaction to exposure of antigenic substances; patch test positive

Irritant Contact Dermatitis (ICD)

  • A non-immunologic skin reaction to skin irritants; patch test negative

    •  

      Allergic Contact Dermatitis (ACD) Irritant Contact Dermatitis (ICD)
    Risk group Genetically predisposed Everyone
    Mechanism of response Immunologic response: Delayed hypersensitivity reactions Non-immunologic: Physical & chemical alteration of the skin epidermis
    Nature of exposure Can be very low concentration of low molecular weight hapten or allergen (eg metals, formalin, epoxy) after one or many exposures Normally high concentration of organic solvent or soaps, etc after few to many exposures
    Onset Usually hours to days Usually minutes to hours
    Distribution May correspond exactly to contactant (eg elastic waist band, wristband); may also be disseminated due to autosensitization Distinct borders in acute ICD Indistinct borders in chronic ICD
    Clinical manifestation Usually in subacute & chronic phase Usually in acute phase
    Diagnostic test Based on positive patch test or usage test Based on trial of avoidance or negative patch test
    Management Complete avoidance of allergens nonpharmacologic & pharmacologic therapy Protection & reduced incidence of exposure

History

Determine trigger factors based on:

  • Medical history
    • Usually identifies the sensitizing agent or allergens in only 10-20% of cases
  • Questioning the relationship between skin condition &:
    • Date of onset
    • Exposure to diapers, hygiene products, personal skin care products, sunscreens, clothing or fabrics w/ dyes, medications, pets, school supplies, sports uniform

Laboratory Tests

Patch Test

  • The gold standard for diagnosing allergic contact dermatitis (ACD)
  • Result reading should be done 48 hours after application
  • Allot another 30 minutes after application for erythema to settle after removing the tape/chamber
  • Second reading must be done 3-7 days after initial patch application
  • Results should be correlated w/ patient’s medical history
  • Should only be done to children <6 years old w/ high degree of clinical suspicion for specific allergens
  • Recommended in cases where symptoms persist despite avoidance of trigger factors & topical therapy
  • Not recommended as a diagnostic test for irritant contact dermatitis (ICD)
  • Avoid when allergic contact dermatitis (ACD) is active, flaring & covers >25% of body surface area (BSA)
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