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

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

• 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

• 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)

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)

• Most common type of contact dermatitis 
• 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
• Often arises from few brief exposures or a single immense exposure to strong irritants or caustic agents

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