CONTACT DERMATITIS

For many parents, especially those new to parenthood, our babies and children are the center of our worlds. At slightest signs of a cold or runny nose most parents will move heaven and Earth to make the baby comfortable. And then if she sees red bumps or blisters develop on the little one’s tender skin, outright panic might only be a step away. The questions are numerous. What are the bumps? Where do they can from? What do I do? The first step is easy. Relax! There is no need to panic. It might be just contact dermatitis, a common ailment occurring in children.

What Is Contact Dermatitis?

Contact dermatitis is an inflammation of skin caused by certain substances called allergens, which produce rashes and itching on your child’s skin. It is a hypersensitivity reaction to an otherwise common substance in your surroundings. There are two types of contact dermatitis. The first is the irritant type. The second is the allergic type (Atopic Dermatitis).

It’s very common for infants and young children to develop irritant contact dermatitis. Allergic contact dermatitis, however, usually occurs after the age of two or three years. This is because an allergic reaction develops after repeated exposure to an allergen that causes the immune system to first recognize it, then react to it. The irritant type of contact dermatitis occurs immediately after the very first contact with the particular substance, whereas allergic contact dermatitis occurs one to two days after exposure to the allergen.

Most parents have experienced problems with their baby’s diapers. We commonly hear of baby rash, diaper rash and drool rash.[1] Both of these are examples of irritant contact dermatitis.

Common Triggers

The most common irritants are soaps, saliva, urine, detergents, and baby lotions. Latex is another common substance which irritates children’s delicate skin. Latex is made from rubber and is typically found in toys, balls, balloons, pacifiers, and bottle nipples. Additional common allergens are plants like poison ivy and metals like nickel. Any substance contaminated by the touch of poison ivy becomes a trigger for allergic contact dermatitis. Nickel is commonly found in zippers and hooks of clothes. [2] These irritants, unfortunately, are an integral part of the child’s small world.

What Does Contact Dermatitis Look Like?

Contact dermatitis will present as redness, swelling, scaling, crusting, blistering and oozing on the affected area. However, the most troublesome symptom is itching and burning that makes the child irritable and restless. The child will constantly try to rub the affected part or might simply cry. Contact dermatitis is usually limited to the area where the substance has come into contact with the skin. It is never contagious and does not spread to the entire body. Contact dermatitis is self-limiting most of the time, and it will subside in one to two weeks. However, severe itching calls for attention.

Contact Dermatitis, Atopic Dermatitis, Eczema, Rash

Inflamed atopic dermatitis on the abdomen and the left thigh of a 2 months old child.

Atopic Dermatitis, Contact Dermatitis, Rash, Eczema

Inflamed atopic dermatitis on the head of a 2 month old child.

How To manage An Episode?

The best thing to do is to apply cold, wet compresses to relieve itching and irritation immediately. Next, contact your pediatrician if the symptoms do not seem to subside. Common sense, however, tells us that as long as the irritant is present, no amount of creams or steroids will help, so the most appropriate solution is to prevent contact with these irritants or allergens. In case of drool rash, it is advisable to wipe the baby’s face clean, and for diaper rashes, change diapers more often to prevent wetness and irritation due to urine. The steps are simple. First, identify the substance that is the culprit. Secondly, prevent exposure to the allergen or limit contact with your child’s skin.[3]

A small change for your little one will go a long way in keeping your little one happy.

References:
1. Diaper (napkin) dermatitis: A fold (intertriginous) dermatosis. Tüzün Y, Wolf R, Bağlam S, Engin B.Clin Dermatol. 2015 Jul-Aug;33(4):477-82. doi: 10.1016/j.clindermatol.2015.04.012. Epub 2015 Apr 9.

2. Belt Buckles-Increasing Awareness of Nickel Exposure in Children: A Case Report.Goldenberg A, Admani S, Pelletier JL, Jacob SE.Pediatrics. 2015 Aug 3. pii: peds.2015-0794. [Epub ahead of print]

3. Allergic contact dermatitis in children: a practical approach to management. Bruckner AL, Weston WL.Skin Therapy Lett. 2002 Oct;7(8):3-5. Review.

Images: Used under Creative Commons License CC4, No Changes made. Author

About the author

Pradip Narsaria, MD

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