Allergic contact dermatitis (pediatric) in Infant/Neonate
See also in: AnogenitalAlerts and Notices
Synopsis
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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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 generalized and flexural in infants)
- Irritant diaper dermatitis – history of irritant exposure; resolves with low- to mid-potency steroids and gentle skin care
- 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
- Candidiasis (male, female) – more prominent papular or pustular component
- Acrodermatitis enteropathica
- Langerhans cell histiocytosis
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Last Reviewed:08/03/2021
Last Updated:08/04/2021
Last Updated:08/04/2021
Patient Information for Allergic contact dermatitis (pediatric) in Infant/Neonate
Overview
Allergic contact dermatitis is an inflammation of the skin caused by an allergy to a substance (the allergen). Unlike irritant dermatitis, which occurs at the time of the allergen touching the skin, contact dermatitis occurs 48-72 hours after exposure. The initial exposure does not cause the rash, but it sensitizes the skin to the next exposure.The most frequent triggers causing allergic contact dermatitis include:
- Perfumes, nickel, neomycin, formaldehyde, lanolin, oxybenzone, and other chemicals common in the environment.
- Poison ivy, poison oak, and poison sumac.
Who’s At Risk
Allergic contact dermatitis can occur at any age. However, the most common causes of allergic contact dermatitis in infants vary from the most common causes in older children and adults. Because infants are typically protected from the outside environment (eg, the poison ivy plant), the most common causes of allergic contact dermatitis are to ingredients in creams and soaps.Signs & Symptoms
Contact dermatitis may occur anywhere on the body. Exposed areas such as the arms, legs, and face are most often affected. Scaly red-to-pink sheets of skin (plaques) and blisters may appear. Individual lesions have distinct (well-demarcated) borders and often assume shapes with straight edges and right angles. Eyelid swelling frequently occurs when the allergen is transferred from your finger to your eyelid. Affected areas are usually severely itchy.When the dermatitis is long-standing, thickened plaques develop, and infection with bacteria may occur.
Self-Care Guidelines
- Avoid whatever is triggering the contact dermatitis.
- Apply cool water compresses to cleanse the area, and then apply over-the-counter 0.5–1% hydrocortisone cream twice daily.
- Calamine lotion and oral antihistamines (chlorpheniramine or diphenhydramine) may reduce the itching. Topical (applied to the skin) antihistamines should be avoided.
When to Seek Medical Care
See your child's doctor or a dermatologist for evaluation if the rash from contact dermatitis does not heal or keeps coming back and does not improve with self-care measures.Treatments
- Treatment of contact dermatitis is aimed at preventing contact with the allergen. Symptoms may be controlled with oral antihistamines.
- Medium-potency topical steroids may be prescribed for rash occurring on the arms or legs (extremities) or trunk.
- Mild-potency topical steroids may be prescribed for use on the thinner skin of the face and skin-fold areas.
- Use the lowest potency topical steroids for the shortest period of time necessary.
- The doctor may do patch testing for allergies if the cause of the contact dermatitis is not known.
References
Bolognia, Jean L., ed. Dermatology, pp.223, 239, 253-256. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.1109-1110, 1313, 2326. New York: McGraw-Hill, 2003.
Allergic contact dermatitis (pediatric) in Infant/Neonate
See also in: Anogenital