contact%20dermatitis%20(pediatric)
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.

Contact%20dermatitis%20(pediatric) Signs and Symptoms

Definition

  • An eczematous eruption due to exposure to an irritating local substance (irritant contact dermatitis) or foreign substance causing an allergic response (allergic contact dermatitis)

Etiology

Common Causative Agent
  • Allergic Contact Dermatitis (ACD)
    • Medications, plants, metals (nickel being the most common), foods, fragrances, stabilizers in skin products, chemical sunscreens, preservatives in infant products (eg wet wipes, protective creams, liquid soaps, shampoos), etc
  • Irritant Contact Dermatitis (ICD)
    • Strong alkaline soaps, saliva, citrus juices, bubble bath, sweat, urine and feces (diaper dermatitis), etc
Location of inflammation may suggest trigger factors for ACD and ICD
  • Eg scalp and ears
    • Possible trigger factors: Shampoo, hair dyes, topical medication, spectacles, metal earrings, etc
  • Eg lips, mouth
    • Possible trigger factors: Lip licking/chewing, thumb sucking, excessive drooling, toothpaste, mouthwash
  • Eg face
    • Possible trigger factors: Cosmetics (face make-up, lipstick, nail polish)

Signs and Symptoms

Allergic Contact Dermatitis (ACD)

  • Initially, lesions appear on the cutaneous site of principal exposure; 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
  • A uniformly present feature is pruritus
  • Patch test shows positive reaction to allergen

Acute Allergic Contact Dermatitis (ACD)

  • Acute eruptions present with macular erythema, papules, vesicles and bullae

Subacute Allergic Contact Dermatitis (ACD)

  • Presents with less prominent vesiculations, with scales, crusts, and erythematous patches

Chronic Allergic Contact Dermatitis (ACD)

  • Lesions are usually lichenified, scaling, fissures with or without vesicles
  • Pigmentary changes can occur

Systemic Allergic Contact Dermatitis (ACD)

  • A generalized rash caused by systemic administration of a drug, chemical or food to which the patient has previously been sensitized through topical exposure

Irritant Contact Dermatitis (ICD)

  • May be localized to areas of thin skin (eg eyelids, intertriginous areas) or thick skin (hands, feet) depending on trigger factor

Acute Irritant Contact Dermatitis (ICD)

  • Acute lesions are erythematous and scaly with papules, vesicles, fissures and erosions

Chronic Irritant Contact Dermatitis (ICD)

  • Chronic lesions are dry, erythematous, cracked and lichenified
  • Hardening and adaptation of the skin may occur due to repeated contact with irritants
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