Contact Dermatitis

Published on 10/06/2015 by admin

Filed under Pediatrics

Last modified 10/06/2015

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Contact Dermatitis

Kristen Smith Danielson, MD

Basic Information

Definition

Contact dermatitis is an acute or relapsing skin disorder whose hallmarks are pruritus and skin inflammation caused by some offending agent. The two subtypes are primary irritant and allergic dermatitis.

Synonyms

Diaper dermatitis

Rhus dermatitis

ICD-9-CM Code

692.9 Contact dermatitis

Epidemiology & Demographics

• The incidence in children is unknown, but contact dermatitis represents approximately 20% of all dermatitis in children.

• Almost 50% of all infants have diaper dermatitis at some point; onset is usually between 9 and 12 months of age.

• For irritant dermatitis, common offending agents include saliva, urine, and feces.

• For the allergic subtype, common offending agents are poison ivy and oak (i.e., Rhus dermatitis). Other agents include nickel, topical medications, soaps, and latex.

• Allergic reactions occur about 1 week after the primary exposure (i.e., sensitization phase). Reactions after subsequent exposures may occur within hours.

Clinical Presentation

History

• History taking should be guided by the age of patient and location of the rash.

• A history of known exposure is often difficult to elicit and requires thoughtful questioning.

Physical Examination

• Discrete areas of erythema correspond to the areas of skin exposed to the irritant or allergen.

• Vesiculation, oozing, and erythematous papules may be present, particularly in acute allergic dermatitis.

• In diaper dermatitis, confluent erythema is present on maximal exposure areas, sparing the inguinal folds. More severe forms may be associated with erosions and blister formation and possibly with secondary infection.

• Chronic exposure in allergic and irritant contact reactions leads to lichenification (i.e., thickening) of the skin.

• Id reaction is a secondary, generalized pruritic eruption consisting of fine, erythematous papules and caused by a generalized sensitivity in a person with a localized allergic contact reaction.

• Phytophotodermatitis results from exposure to lime or lemon juice, carrot, or celery followed by exposure to sunlight, and it is characterized by redness, blistering, or hyperpigmentation (may be confused with abuse).

Etiology

• Irritant dermatitis

There is a direct toxic effect to the skin.

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