Allergic contact dermatitis (pediatric) in Infant/Neonate
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. Allergic contact dermatitis is rare in infants but is able to be induced as early as the neonatal period. The most common allergens in infants include nickel (earrings and snaps on clothing), dichromate (leather products, [eg, straps, shoes]), neomycin (topical antibiotic), and oxybenzone (sunscreens). The distribution and geometry of lesions is an important clue to diagnosis.
Per February 2019, isobornyl acrylate was named the "contact allergen of the year" by the American Contact Dermatitis Society. It is an acrylic monomer often used as an adhesive in medical devices, and 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.
Related topic: Diaper irritant contact dermatitis
L23.9 – Allergic contact dermatitis, unspecified cause
40275004 – Contact dermatitis
- Allergic contact dermatitis is exceedingly rare in infants, and other dermatoses should be strongly considered before making this diagnosis. 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, localized to seborrheic areas.
- 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 is accompanied by pain, fever, and systemic symptoms.
- Dyshidrotic dermatitis
- Tinea corporis (rare in infants).