Irritant contact dermatitis in Child
See also in: External and Internal Eye,AnogenitalAlerts and Notices
Synopsis
Irritant contact dermatitis should be differentiated from true allergic contact dermatitis, which is a delayed type-IV hypersensitivity (immune) reaction. Patients typically present complaining of a burning or stinging sensation early in the course of irritant contact dermatitis. Symptoms and a rash usually follow the exposure by hours if the irritant is strong; this is in contrast to allergic contact dermatitis, where symptoms are usually delayed by approximately 2 days following exposure. As the irritation becomes chronic and the skin continually inflamed, pruritus can become a predominant symptom.
Any body surface can be a location for irritant contact dermatitis. The hands are a common location in older children (see also hand dermatitis). The face and diaper area are commonly involved in younger children, such as in diaper dermatitis. Saliva in young babies who are teething or using bottles and pacifiers can cause irritant dermatitis on the cheeks and chin. Irritant dermatitis from cleansers used on toilet seats presents as dermatitis on the buttocks and posterior thighs.
Patients with a history of atopic dermatitis are particularly predisposed. Environmental factors include repeated exposure to water or frequent hand washing, hand sanitizers, soaps and solvents, fiberglass, mild acids, and alkalis. Dry air can also predispose to irritant contact dermatitis. Irritant contact dermatitis can occur at any age from infancy to adulthood.
Irritant contact dermatitis will improve when the child is no longer exposed to the irritant, such as a hand dermatitis that improves during summers and school breaks when a child is no longer using a particular hand sanitizer daily.
Codes
ICD10CM:L24.9 – Irritant contact dermatitis, unspecified cause
SNOMEDCT:
110979008 – Primary irritant dermatitis
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Allergic contact dermatitis has a delayed onset compared to irritant contact dermatitis and can be more widespread.
- Atopic dermatitis is usually marked by diffuse xerosis with eczematous plaques in the flexural regions, but older children may have marked acral involvement of their atopic dermatitis.
- Nummular dermatitis (nummular eczema) has slightly lichenified, glazed plaques with multiple erosions throughout the body that are intensely pruritic.
- Dyshidrotic dermatitis (dyshidrotic eczema) presents as small pruritic vesicles on the hands with some desquamation.
- Phytophotodermatitis may often present in similar geometric lesions after exposure to a triggering agent and subsequent sun exposure.
- Intertrigo if present in skin folds.
- Tinea corporis – When a patient presents with scaling lesions (especially on the hands or feet), it is important to perform a potassium hydroxide (KOH) preparation to rule out a fungal etiology.
- Psoriasis can also present as well-demarcated plaques on the hands, feet, and groin in children. Look for scalp, ear, umbilical, and nail plate involvement as signs favoring psoriasis over irritant contact dermatitis.
- Pityriasis rosea develops from one initial herald patch, often on the trunk, into a widespread eruption of papules and plaques with a trailing edge of scale that follow Langer lines of cleavage on the trunk.
- Seborrheic dermatitis will present as yellow-white greasy scale on erythematous papules and plaques on the scalp, face, and upper trunk of young infants and teenagers.
- Lichen simplex chronicus lesions are pruritic and lichenified to hypertrophic papules and plaques at the site of repeated scratching or rubbing.
- Scabies – Look for burrows in the web spaces of hands and feet. Scabies in young children may have a mixed morphology and be widespread.
- Cellulitis has the classic signs of warmth, erythema, and induration with an advancing border, often without as much epidermal change as irritant contact dermatitis.
- Erysipelas
- Herpes simplex virus (HSV) infection will present with punched-out, scalloped-border erosions. Tzanck smear, direct fluorescent antibody (DFA) test, and viral culture are all ways to differentiate irritant contact dermatitis and HSV infection.
- Impetigo lesions often have a yellow crusting and will have positive bacterial culture.
- Pellagra
- Drug eruption
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:10/17/2017
Last Updated:02/04/2021
Last Updated:02/04/2021
Patient Information for Irritant contact dermatitis in Child
Overview
Irritant contact dermatitis is caused by direct chemical injury, repeated rubbing (friction), or injury of any kind to the skin. Irritant contact dermatitis is not the same as true allergic contact dermatitis, which is a delayed allergic response caused by a reaction with the immune system, where a rash appears 48-72 hours after exposure to the triggering substance (an allergen).People with irritant contact dermatitis usually have burning or stinging soon after the rash appears. Symptoms and rash associated with irritant contact dermatitis usually occur within hours if exposed to a strong irritant. As the irritation continues and the skin becomes constantly inflamed, the burning, stinging rash can become severe.
Who’s At Risk
Irritant contact dermatitis can occur in people of any age and especially in people who have eczema. Common triggers of irritant contact dermatitis include:- Repeated exposure to water
- Frequent hand washing
- Exposure to harsh chemicals (such as solvents), fiberglass, mild acids, and chemicals with a high pH (alkalis)
- Dry air
Signs & Symptoms
The most common location for irritant contact dermatitis is the hands, although any body surface can be affected, including the genitals.Irritant contact dermatitis may appear as pink-to-red lesions. Sheets of skin (plaques) become scaly and crack in areas of long-term (chronic) exposure. If the lesions appear quickly (acutely), patches and plaques may have a sharp border at the exposed areas. On the fingertips, you might see peeling of the skin, cracks, and scaling.
Self-Care Guidelines
Help your child with the following:- Remove whatever chemical or condition is causing the irritation, and protect the skin from further exposure.
- For irritated skin in body folds, try using a barrier cream with zinc oxide paste, such as Desitin.
- If the area is dry and cracked, moisturize the area frequently by dampening with water and then applying a softening cream such as petroleum jelly (Vaseline) or a moisturizer.
- For itchy, red areas, try applying over-the-counter hydrocortisone cream (0.5-1%) twice daily.
When to Seek Medical Care
See your child's doctor or a dermatologist if the rash does not go away with self-care measures.Treatments
- The doctor may recommend applying petroleum jelly or a thick moisturizing cream directly to your child's wet skin after bathing. Apply these creams frequently (at least twice daily) to moisturize and protect the skin.
- The doctor may prescribe mild-to-moderate-potency topical steroids if inflammation is present.
References
Bolognia, Jean L., ed. Dermatology, pp.227, 241-249. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1309-1314, 2370. New York: McGraw-Hill, 2003.
Irritant contact dermatitis in Child
See also in: External and Internal Eye,Anogenital