Irritant contact dermatitis in Infant/Neonate
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.
L24.9 – Irritant contact dermatitis, unspecified cause
110979008 – Primary irritant dermatitis
- 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.
- 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.
- Drug eruption