Allergic contact dermatitis (pediatric) in Infant/Neonate
Contact dermatitis can be due to either allergic or irritant causes. Irritant contact dermatitis is due to nonimmunologic local exposure of the skin to an irritating substance. Allergic contact dermatitis is a cutaneous inflammatory process (type IV cell-mediated or delayed hypersensitivity reaction) usually localized to areas where allergens contact the skin. Beyond the area of primary contact, a secondary dermatitis may develop. Initial sensitization and development of cutaneous inflammation takes 1-4 weeks; however, repeat exposure produces reactions within 48 hours or less.
In children, allergic contact dermatitis is more common after the age of 5 years, but younger children can become sensitized. An estimated 4.4 million children are affected by contact dermatitis in the United States. Allergic contact dermatitis is rare in infants but can be induced as early as the neonatal period.
Diapers, powder, creams, and products used in toileting may instigate contact dermatitis in infants and toddlers. Infants requiring supplemental nutrition via a stoma may develop irritant dermatitis to adhesives. Areas under occlusion or with active erosion are at higher risk for allergen penetration and subsequent allergic contact dermatitis.
Related topic: diaper irritant contact dermatitis
L23.9 – Allergic contact dermatitis, unspecified cause
238575004 – Allergic contact dermatitis
Differential Diagnosis & Pitfalls
For example, allergic contact dermatitis in the diaper area should be distinguished from other diaper dermatoses; severe bullous allergic contact dermatitis should be distinguished from other bullous disorders; and chronic, lichenified allergic contact dermatitis should be distinguished from the papulosquamous dermatoses.
- Seborrheic dermatitis – less pruritic, less erythematous (salmon hue instead of bright red), localized to seborrheic areas (although can be generalized and flexural in infants)
- Irritant diaper dermatitis – history of irritant exposure; resolves with low- to mid-potency steroids and gentle skin care
- Impetigo – flaccid bullae, honey-colored crust, with ill-defined, nongeometric borders
- Cellulitis – accompanied by pain, fever, and systemic symptoms
- Dyshidrotic dermatitis (rare in infants)
- Tinea corporis (rare in infants)
- Infantile psoriasis – facial and diaper involvement, very well-demarcated plaques