Contact Dermatitis
Contact Dermatitis is a topic covered in the Select 5-Minute Pediatrics Topics.
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Basics
Description
An acute or chronic inflammation of the dermis and epidermis as result of either direct irritation to the skin (irritant contact dermatitis) or delayed-type (type IV) hypersensitivity reaction to a contact allergen (allergic contact dermatitis)
Epidemiology
Incidence
Incidence in children is not known.
Prevalence
- Irritant contact dermatitis: Most cases of contact dermatitis (>80%) are irritant contact dermatitis.
- Skin reactivity is highest in infants and tends to decrease with age.
- Allergic contact dermatitis
- Because children have less time to develop sensitivities, it is less common in infants and children than in adults.
- Prevalence increases with age.
- Overall prevalence is ~13–23% and has been increasing in children, perhaps due to more frequent exposure to allergens at a younger age or improved diagnosis.
Risk Factors
- Irritant contact dermatitis
- Frequent hand washing or water immersion
- Atopic dermatitis: Chronically impaired barrier function increases susceptibility to irritants.
- Genetic factors
- Environmental factors such as cold/hot temperatures or high/low humidity disrupt the skin barrier.
- Allergic contact dermatitis
- Atopic dermatitis
- Genetic factors
- Increased exposure to allergens
General Prevention
Minimize contact exposure to known or potential irritants and allergens.
Pathophysiology
- Irritant contact dermatitis does not involve an immune response and thus can occur with the first exposure to the irritant. Multiple mechanisms are involved, including the following:
- Disruption of the epidermal barrier by chemicals (soaps, detergents) or physical irritants (moisture, friction)
- Damage to cell membranes and cytotoxic effect on skin cells
- Chronic exposure may stimulate cell proliferation, resulting in acanthosis and hyperkeratosis. Postinflammatory hypo- or hyperpigmentation may result.
- Allergic contact dermatitis requires initial exposure and sensitization to an allergen and only occurs in susceptible individuals. Repeated exposure leads to the development of a type IV hypersensitivity reaction.
- Both processes result in nonspecific findings of dermal and epidermal edema and inflammation and may be indistinguishable from other forms of inflammatory dermatitis.
Etiology
- Irritant contact dermatitis
- Frequent hand washing or water immersion
- Soaps and detergents
- Saliva (lip licking or thumb sucking)
- Urine and feces (see “Diaper Rash”)
- High concentrations of most chemicals can induce irritant contact dermatitis, whereas mild irritants may induce inflammation only in susceptible individuals.
- Allergic contact dermatitis
- Nickel and other metals (gold, cobalt)
- Hair products (ammonium, 5-diamine)
- Solvents (toluene-2)
- Additives to medications, cosmetics (thimerosal, mercuric chloride)
- Rubber
- Fragrances (Balsam of Peru)
- Clothing dyes
- Formaldehydes
- Topical antibiotics (neomycin, bacitracin)
- Plants (Toxicodendron species; e.g., poison ivy, poison oak, and poison sumac, which contain the allergen urushiol)
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Basics
Description
An acute or chronic inflammation of the dermis and epidermis as result of either direct irritation to the skin (irritant contact dermatitis) or delayed-type (type IV) hypersensitivity reaction to a contact allergen (allergic contact dermatitis)
Epidemiology
Incidence
Incidence in children is not known.
Prevalence
- Irritant contact dermatitis: Most cases of contact dermatitis (>80%) are irritant contact dermatitis.
- Skin reactivity is highest in infants and tends to decrease with age.
- Allergic contact dermatitis
- Because children have less time to develop sensitivities, it is less common in infants and children than in adults.
- Prevalence increases with age.
- Overall prevalence is ~13–23% and has been increasing in children, perhaps due to more frequent exposure to allergens at a younger age or improved diagnosis.
Risk Factors
- Irritant contact dermatitis
- Frequent hand washing or water immersion
- Atopic dermatitis: Chronically impaired barrier function increases susceptibility to irritants.
- Genetic factors
- Environmental factors such as cold/hot temperatures or high/low humidity disrupt the skin barrier.
- Allergic contact dermatitis
- Atopic dermatitis
- Genetic factors
- Increased exposure to allergens
General Prevention
Minimize contact exposure to known or potential irritants and allergens.
Pathophysiology
- Irritant contact dermatitis does not involve an immune response and thus can occur with the first exposure to the irritant. Multiple mechanisms are involved, including the following:
- Disruption of the epidermal barrier by chemicals (soaps, detergents) or physical irritants (moisture, friction)
- Damage to cell membranes and cytotoxic effect on skin cells
- Chronic exposure may stimulate cell proliferation, resulting in acanthosis and hyperkeratosis. Postinflammatory hypo- or hyperpigmentation may result.
- Allergic contact dermatitis requires initial exposure and sensitization to an allergen and only occurs in susceptible individuals. Repeated exposure leads to the development of a type IV hypersensitivity reaction.
- Both processes result in nonspecific findings of dermal and epidermal edema and inflammation and may be indistinguishable from other forms of inflammatory dermatitis.
Etiology
- Irritant contact dermatitis
- Frequent hand washing or water immersion
- Soaps and detergents
- Saliva (lip licking or thumb sucking)
- Urine and feces (see “Diaper Rash”)
- High concentrations of most chemicals can induce irritant contact dermatitis, whereas mild irritants may induce inflammation only in susceptible individuals.
- Allergic contact dermatitis
- Nickel and other metals (gold, cobalt)
- Hair products (ammonium, 5-diamine)
- Solvents (toluene-2)
- Additives to medications, cosmetics (thimerosal, mercuric chloride)
- Rubber
- Fragrances (Balsam of Peru)
- Clothing dyes
- Formaldehydes
- Topical antibiotics (neomycin, bacitracin)
- Plants (Toxicodendron species; e.g., poison ivy, poison oak, and poison sumac, which contain the allergen urushiol)
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