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Allergic contact dermatitis (pediatric) in Infant/Neonate
See also in: Anogenital
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Allergic contact dermatitis (pediatric) in Infant/Neonate

See also in: Anogenital
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Contributors: Nnenna Agim MD, 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, 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. The most common allergens in infants include fragrance and preservatives (contained in skin care products for the infant and parent, and laundry detergents), nickel (earrings and snaps on clothing), dichromate (leather products, [eg, straps, shoes]), neomycin (topical antibiotic), and oxybenzone (sunscreens). 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.

The distribution and geometry of lesions is an important clue to diagnosis.

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.
In anogenital locations, also consider:
  • Candidiasis – more prominent papular or pustular component

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Therapy

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Last Reviewed: 01/22/2020
Last Updated: 01/24/2020
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Allergic contact dermatitis (pediatric) in Infant/Neonate
See also in: Anogenital
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Allergic contact dermatitis (pediatric) : Erythema, Vesicle, Pruritus
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A scaly, hyperpigmented plaque developing on the wrist under a watch, secondary to allergic contact dermatitis to nickel.
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