Contact Dermatitis in Pediatrics

Contact dermatitis is an inflammatory skin condition resulting from external contact with irritants or allergens. It represents one of the most common skin disorders in children, affecting up to 20% of the pediatric population.

Key Points:

• Increasing prevalence in children
• Can occur at any age, including infancy
• Significant impact on quality of life
• Often preventable with proper identification of triggers
• May indicate future atopic conditions

Major Types

1. Irritant Contact Dermatitis (ICD)

• Pathophysiology:
  • Direct cellular damage
  • Non-immunologic response
  • Disruption of skin barrier
  • Release of pro-inflammatory mediators
• Characteristics:
  • More common (80% of cases)
  • Occurs on first exposure
  • Dose-dependent response
  • Limited to area of contact

2. Allergic Contact Dermatitis (ACD)

• Pathophysiology:
  • Type IV delayed hypersensitivity reaction
  • Requires sensitization phase
  • T-cell mediated response
  • Memory cell formation
• Characteristics:
  • Develops 48-96 hours after exposure
  • Can spread beyond contact area
  • Requires prior sensitization
  • More severe with repeated exposure

Presentation Patterns

Irritant Contact Dermatitis

• Acute Features:
  • Burning/stinging sensation
  • Erythema and edema
  • Well-demarcated borders
  • Possible vesiculation
• Chronic Features:
  • Xerosis and scaling
  • Lichenification
  • Fissuring
  • Hyperkeratosis

Allergic Contact Dermatitis

• Acute Features:
  • Intense pruritus
  • Erythematous plaques
  • Vesicles and bullae
  • Possible spreading phenomenon
• Chronic Features:
  • Lichenification
  • Pigmentary changes
  • Persistent pruritus
  • Secondary infection risk

Common Distribution Patterns

• Diaper area (irritant)
• Face and neck (cosmetics, jewelry)
• Hands and feet (shoes, gloves)
• Perioral region (food, lip products)
• Sites of medical devices/adhesives

Irritant Triggers

• Physical Factors:
  • Friction
  • Occlusion
  • Temperature extremes
  • Excessive moisture
• Chemical Agents:
  • Soaps and detergents
  • Cleansers
  • Acids and alkalis
  • Solvents
• Biological Substances:
  • Saliva
  • Urine and feces
  • Food products
  • Plant sap

Common Allergens

• Metals:
  • Nickel
  • Chromium
  • Cobalt
• Preservatives:
  • Methylisothiazolinone
  • Formaldehyde releasers
  • Parabens
• Natural Substances:
  • Plant resins (urushiol)
  • Natural rubber latex
  • Essential oils
• Personal Care Products:
  • Fragrances
  • Hair dyes
  • Sunscreens

Diagnostic Approach

• Clinical History:
  • Temporal relationship
  • Exposure history
  • Pattern recognition
  • Previous reactions
• Physical Examination:
  • Morphology assessment
  • Distribution pattern
  • Secondary changes
  • Associated findings

Specific Testing

• Patch Testing:
  • Gold standard for ACD
  • Standard series
  • Custom allergens
  • Reading at 48h and 96h
• Additional Studies:
  • Skin biopsy (rarely needed)
  • Photography documentation
  • Product analysis

Differential Diagnosis

• Atopic dermatitis
• Seborrheic dermatitis
• Psoriasis
• Impetigo
• Tinea infections
• Drug reactions

Acute Management

• Immediate Measures:
  • Allergen/irritant removal
  • Gentle cleansing
  • Cool compresses
  • Protection from further exposure
• Topical Therapy:
  • Corticosteroids:
    • Mild to moderate strength
    • Based on site and severity
    • Limited duration
  • Calcineurin inhibitors
  • Barrier repair products

Systemic Treatment

• Indications:
  • Severe reactions
  • Widespread involvement
  • Significant symptoms
• Options:
  • Oral antihistamines
  • Systemic corticosteroids
  • Pain management

Supportive Care

• Moisturization
• Wound care if needed
• Prevention of secondary infection
• Treatment of complications

Preventive Strategies

• Primary Prevention:
  • Trigger identification
  • Avoidance measures
  • Protective equipment
  • Environmental modifications
• Skin Care:
  • Regular moisturization
  • Gentle cleansers
  • Barrier protection
  • pH-balanced products

Education

• Patient/Family Education:
  • Trigger recognition
  • Early warning signs
  • Proper skin care
  • When to seek help
• School/Caregiver Education:
  • Avoidance strategies
  • Emergency measures
  • Documentation needs

High-Risk Populations

• Atopic Individuals:
  • Increased susceptibility
  • Modified management
  • Prevention strategies
• Occupational Exposure:
  • Specific triggers
  • Protective measures
  • Legal considerations

Special Locations

• Face:
  • Gentle products
  • Modified treatment
  • Cosmetic concerns
• Hands:
  • Frequent exposure
  • Prevention strategies
  • Occupational impact
• Diaper Area:
  • Barrier protection
  • Frequent changes
  • Gentle cleaning

Expected Outcomes

• Short-term:
  • Resolution with treatment
  • Symptom improvement
  • Prevention of spread
• Long-term:
  • Risk of recurrence
  • Need for ongoing prevention
  • Quality of life impact

Follow-up Care

• Monitoring:
  • Treatment response
  • Complication prevention
  • Trigger identification
• Long-term Management:
  • Prevention strategies
  • Regular assessment
  • Quality of life evaluation