Allergic contact dermatitis (pediatric) in Child
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) localized to areas where allergens contact the skin. Initial sensitization and development of cutaneous inflammation takes 1-4 weeks; however, repeat exposure produces reactions within 48 hours.
In children, allergic contact dermatitis is more common after the age of 5 years, but younger children can become sensitized. The incidence and prevalence of contact dermatitis has increased steadily over the decades; an estimated 4.4 million children are affected in the United States. This figure reflects those presenting for evaluation; many more affected children may remain undiagnosed.
The most common contact allergens in children are:
- Fragrance (eg, balsam of Peru [Myroxylon balsamum var pereirae]) and preservatives (eg, formaldehyde, quaternium-15, methylchloroisothiazolinone / methylisothiazolinone) – contained in cosmetic and personal care products for the child and parent, toys, glue, perfume, slime, household cleaning products, laundry detergents
- Nickel – jewelry, food, toys, clothing, snaps on clothing, electronics
- Cobalt – metal-plated products, crayons, deodorant (see also cobalt toxicity)
- Dichromate – leather products (eg, straps, shoes)
- Neomycin and bacitracin – topical antibiotics
- Oxybenzone – sunscreens
- Lanolin (Amerchol L101), propylene glycol, cocamidopropyl betaine – emollients and surfactants found in baby soap, shampoo, moisturizer, lip balm, cosmetics, packaged foods, cleaning products
American Contact Dermatitis Society Allergen of the Year:
- 2020 – Isobornyl acrylate, an acrylic monomer often used as an adhesive in medical devices. There have been multiple case reports of diabetes patients developing contact allergies to their insulin pumps. Clinician awareness is important because testing using routine panels does not identify isobornyl acrylate.
- 2021 – Acetophenone azine, thought to be formed in situ through reactions between ethyl vinyl acetate, which is present in foams used for cushioning in shin pads and footwear, and other additives. Reactions have been noted mostly in children and teens ("soccer shin" contact dermatitis).
Codes
ICD10CM:L23.9 – Allergic contact dermatitis, unspecified cause
SNOMEDCT:
238575004 – Allergic contact dermatitis
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Differential Diagnosis & Pitfalls
- Tinea pedis – often affects toe webs and is usually asymmetric
- Tinea manuum
- Juvenile plantar dermatosis
- Dyshidrotic dermatitis
- Tinea corporis
- Psoriasis
- Seborrheic dermatitis – less pruritic, localized to seborrheic areas
- Irritant contact dermatitis – history of irritant exposure; resolves with low- to mid-potency steroids and gentle skin care
- Atopic dermatitis – history of atopy, characteristic location of lesions (flexures, face, and acral extremities)
- Impetigo – flaccid bullae and honey-colored crust, with ill-defined, nongeometric borders
- Cellulitis – accompanied by pain, fever, and systemic symptoms
- Phytophotodermatitis – a phototoxic eruption
- Candidiasis (male, female)
- Psoriasis, intertriginous variant
- Inflammatory bowel disease, cutaneous manifestations (Crohn disease, ulcerative colitis)
- Acrodermatitis enteropathica
- Langerhans cell histiocytosis
- Early lichen sclerosus
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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:06/30/2022
Last Updated:06/30/2022
Patient Information for Allergic contact dermatitis (pediatric) in Child
Overview
Allergic contact dermatitis is an allergy to a substance (the allergen) touching the skin. The reaction occurs 48-72 hours after exposure. Common allergens are nickel, chromates, rubber chemicals, and neomycin (an antibacterial medication).- Nickel is found in jewelry, belt buckles, and metal closures on clothing.
- Chromates are found in shoe leathers.
- Rubber chemicals are found in gloves, balloons, and elastic in clothes.
- Neomycin is common in triple-antibiotic first-aid ointments such as Neosporin (and generic versions of Neosporin) as well as other combination preparations containing other antibacterials and corticosteroids, as well as other topical ointments, creams, and lotions. It may also be found in eye medications, eardrops, and some vaccines.
- Common allergen-containing products include sunscreens (oxybenzone [benzophenone-3]), cosmetics, soaps, dyes, and jewelry.
- The most frequent triggers are fragrance, nickel, neomycin, formaldehyde, lanolin, and other chemicals that are common in the environment.
- Poison ivy is a frequent cause and is discussed separately.
Who’s At Risk
Allergic contact dermatitis can occur at any age, but it is more common in adults, with women affected more often than men.Signs & Symptoms
Allergic 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 child's finger to his or her 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 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 does not heal or keeps coming back, and it does not improve with self-care measures.Treatments
- Treatment 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 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 Child
See also in: Anogenital