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Allergic contact dermatitis (pediatric) in Infant/Neonate
See also in: Anogenital
Other Resources UpToDate PubMed

Allergic contact dermatitis (pediatric) in Infant/Neonate

See also in: Anogenital
Contributors: Vivian Wong MD, PhD, Nnenna Agim MD, FAAD, Craig N. Burkhart MD, Dean Morrell MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

This summary discusses pediatric patients. Allergic contact dermatitis in adults is addressed separately.

Contact dermatitis can be due to either allergic or irritant causes. Irritant contact dermatitis is due to nonimmunologic local exposure of the skin to an irritating substance. Allergic contact dermatitis is a cutaneous inflammatory process (type IV cell-mediated or delayed hypersensitivity reaction) usually localized to areas where allergens contact the skin. Beyond the area of primary contact, a secondary dermatitis may develop. Initial sensitization and development of cutaneous inflammation takes 1-4 weeks; however, repeat exposure produces reactions within 48 hours or less.

In children, allergic contact dermatitis is more common after the age of 5 years, but younger children can become sensitized. An estimated 4.4 million children are affected by contact dermatitis in the United States. Allergic contact dermatitis is rare in infants but can be induced as early as the neonatal period.

Diapers, powder, creams, and products used in toileting may instigate contact dermatitis in infants and toddlers. Infants requiring supplemental nutrition via a stoma may develop irritant dermatitis to adhesives. Areas under occlusion or with active erosion are at higher risk for allergen penetration and subsequent allergic contact dermatitis.

Related topic: diaper irritant contact dermatitis

Codes

ICD10CM:
L23.9 – Allergic contact dermatitis, unspecified cause

SNOMEDCT:
238575004 – Allergic contact dermatitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Allergic contact dermatitis is rare in infants, and other dermatoses should be strongly considered before making this diagnosis. It is, however, becoming more common and should be considered where a dermatitis persists despite adequate standard therapy. The differential diagnosis varies depending on the location and severity of the dermatitis.

For example, allergic contact dermatitis in the diaper area should be distinguished from other diaper dermatoses; severe bullous allergic contact dermatitis should be distinguished from other bullous disorders; and chronic, lichenified allergic contact dermatitis should be distinguished from the papulosquamous dermatoses.
  • Seborrheic dermatitis – less pruritic, less erythematous (salmon hue instead of bright red), localized to seborrheic areas (although can be Leiner disease and flexural in infants)
  • Diaper irritant contact dermatitis – history of irritant exposure; resolves with low- to mid-potency steroids and gentle skin care
  • Bullous impetigo – flaccid bullae, honey-colored crust, with ill-defined, nongeometric borders
  • Cellulitis – accompanied by pain, fever, and systemic symptoms
  • Dyshidrotic dermatitis (rare in infants)
  • Tinea corporis (rare in infants)
  • Infantile psoriasis – facial and diaper involvement, very well-demarcated plaques
In anogenital locations, also consider:
  • Candidiasis (Male genital candidiasis, Vulvovaginal candidiasis) – more prominent papular or pustular component
  • Acquired acrodermatitis enteropathica
  • Langerhans cell histiocytosis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:08/03/2021
Last Updated:08/04/2021
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Patient Information for Allergic contact dermatitis (pediatric) in Infant/Neonate
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Allergic contact dermatitis (pediatric) in Infant/Neonate
See also in: Anogenital
A medical illustration showing key findings of Allergic contact dermatitis (pediatric) : Erythema, Vesicle, Pruritus, Developed acutely
Irritant or Object image of Allergic contact dermatitis (pediatric) - imageId=100963. Click to open in gallery.  caption: 'A scaly, hyperpigmented plaque developing on the wrist under a watch, secondary to allergic contact dermatitis to nickel.'
A scaly, hyperpigmented plaque developing on the wrist under a watch, secondary to allergic contact dermatitis to nickel.
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