Lee PW, Elsaie ML, Jacob SE. Allergic contact dermatitis in children: common allergens and treatment: a review. Curr Opin Pediatr. 2009 Aug. 21(4):491-8. [QxMD MEDLINE Link].
Militello G, Jacob SE, Crawford GH. Allergic contact dermatitis in children. Curr Opin Pediatr. 2006 Aug. 18(4):385-90. [QxMD MEDLINE Link].
Sung CT, McGowan MA, Jacob SE. Allergic Contact Dermatitis Evaluation: Strategies for the Preschooler. Curr Allergy Asthma Rep. 2018 Aug 1. 18 (10):49. [QxMD MEDLINE Link].
Fisher AA, Rietschel RL, Fowler JF. Fisher's Contact Dermatitis. 4th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 1995.
Silny W, Bartoszak L, Jenerowicz D, Zukiewicz-Sobczak W, Gozdziewska M. Prevalence of contact allergy in children suffering from atopic dermatitis, seborrhoeic dermatitis and in healthy controls. Ann Agric Environ Med. 2013 Mar 25. 20(1):55-60. [QxMD MEDLINE Link].
Munivrana Skvorc H, Plavec D, Munivrana S, Skvorc M, Nogalo B, Turkalj M. Prevalence of and risk factors for the development of atopic dermatitis in schoolchildren aged 12-14 in northwest Croatia. Allergol Immunopathol (Madr). 2012 Dec 17. [QxMD MEDLINE Link].
de Lagrán ZM, de Frutos FJ, de Arribas MG, Vanaclocha-Sebastián F. Contact urticaria to raw potato. Dermatol Online J. 2009 May 15. 15(5):14. [QxMD MEDLINE Link].
Kennedy JL, Stallings AP, Platts-Mills TA, Oliveira WM, Workman L, James HR, et al. Galactose-a-1,3-galactose and Delayed Anaphylaxis, Angioedema, and Urticaria in Children. Pediatrics. 2013 Apr 8. [QxMD MEDLINE Link].
Salvaggio HL, Scheman AJ, Chamlin SL. Shock Treatment: Swimming Pool Contact Dermatitis. Pediatr Dermatol. 2012 Nov 7. [QxMD MEDLINE Link].
Seth D, Poowuttikul P, Kamat D, Pansare M. Contact Dermatitis in Children. Pediatr Ann. 2021 May. 50 (5):e198-e205. [QxMD MEDLINE Link].
Jacob SE, McGowan M, Silverberg NB, Pelletier JL, Fonacier L, Mousdicas N, et al. Pediatric Contact Dermatitis Registry Data on Contact Allergy in Children With Atopic Dermatitis. JAMA Dermatol. 2017. 153:765-770. [QxMD MEDLINE Link].
Spencer A, Gazzani P, Thompson DA. Acrylate and methacrylate contact allergy and allergic contact disease: a 13-year review. Contact Dermatitis. 2016 Sep. 75 (3):157-64. [QxMD MEDLINE Link].
Muttardi K, White IR, Banerjee P. The burden of allergic contact dermatitis caused by acrylates. Contact Dermatitis. 2016 Sep. 75 (3):180-4. [QxMD MEDLINE Link].
Liu T, Wan J, McKenna RA, Jackson OA, Treat JR. Allergic contact dermatitis caused by Dermabond in a paediatric patient undergoing skin surgery. Contact Dermatitis. 2019 Jan. 80 (1):61-62. [QxMD MEDLINE Link].
Akan A, Toyran M, Vezir E, Azkur D, Kaya A, Erkoçoğlu M, et al. The patterns and clinical relevance of contact allergen sensitization in a pediatric population with atopic dermatitis. Turk J Med Sci. 2015. 45 (6):1207-13. [QxMD MEDLINE Link].
Yu J, Treat J, Chaney K, Brod B. Potential Allergens in Disposable Diaper Wipes, Topical Diaper Preparations, and Disposable Diapers: Under-recognized Etiology of Pediatric Perineal Dermatitis. Dermatitis. 2016 May-Jun. 27 (3):110-8. [QxMD MEDLINE Link].
Chang MW, Nakrani R. Six children with allergic contact dermatitis to methylisothiazolinone in wet wipes (baby wipes). Pediatrics. 2014 Feb. 133 (2):e434-8. [QxMD MEDLINE Link].
Silverberg JI, Warshaw EM, Maibach HI, DeKoven JG, Taylor JS, Atwater AR, et al. Hand eczema in children referred for patch testing: North American Contact Dermatitis Group Data, 2000-2016. Br J Dermatol. 2021 Jul. 185 (1):185-194. [QxMD MEDLINE Link].
Clemmensen O, Hjorth N. Perioral contact urticaria from sorbic acid and benzoic acid in a salad dressing. Contact Dermatitis. 1982 Jan. 8(1):1-6. [QxMD MEDLINE Link].
Brasch J, Geier J. Patch test results in schoolchildren. Results from the Information Network of Departments of Dermatology (IVDK) and the German Contact Dermatitis Research Group (DKG). Contact Dermatitis. 1997 Dec. 37(6):286-93. [QxMD MEDLINE Link].
Warshaw E, Lee G, Storrs FJ. Hand dermatitis: a review of clinical features, therapeutic options, and long-term outcomes. Am J Contact Dermat. 2003 Sep. 14(3):119-37. [QxMD MEDLINE Link].
Raikhlin-Eisenkraft B. Contact dermatitis from occupation-induced injury. Isr Med Assoc J. 2009 May. 11(5):322. [QxMD MEDLINE Link].
Fenner J, Hadi A, Yeh L, Silverberg N. Hidden risks in toys: A systematic review of pediatric toy contact dermatitis. Contact Dermatitis. 2020 May. 82 (5):265-271. [QxMD MEDLINE Link].
Neale H, Garza-Mayers AC, Tam I, Yu J. Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children. J Am Acad Dermatol. 2021 Feb. 84 (2):235-244. [QxMD MEDLINE Link].
Litvinov IV, Sugathan P, Cohen BA. Recognizing and treating toilet-seat contact dermatitis in children. Pediatrics. 2010 Feb. 125(2):e419-22. [QxMD MEDLINE Link].
Pigatto P, Martelli A, Marsili C, Fiocchi A. Contact dermatitis in children. Ital J Pediatr. 2010 Jan 13. 36:2. [QxMD MEDLINE Link]. [Full Text].
Borok J, Matiz C, Goldenberg A, Jacob SE. Contact Dermatitis in Atopic Dermatitis Children-Past, Present, and Future. Clin Rev Allergy Immunol. 2018 Sep 17. [QxMD MEDLINE Link].
Yu J, Atwater AR, Brod B, Chen JK, Chisolm SS, Cohen DE, et al. Pediatric Baseline Patch Test Series: Pediatric Contact Dermatitis Workgroup. Dermatitis. 2018. 29:206-212. [QxMD MEDLINE Link].
Yu J, Atwater AR, Brod B, Chen JK, Chisolm SS, Cohen DE, et al. Pediatric Baseline Patch Test Series: Pediatric Contact Dermatitis Workgroup. Dermatitis. 2018 Jul/Aug. 29 (4):206-212. [QxMD MEDLINE Link].
Tamazian S, Oboite M, Treat JR. Patch testing in skin of color: A brief report. Pediatr Dermatol. 2021 Mar 20. [QxMD MEDLINE Link].
Fonacier LS, Aquino MR, Mucci T. Current strategies in treating severe contact dermatitis in pediatric patients. Curr Allergy Asthma Rep. 2012 Dec. 12(6):599-606. [QxMD MEDLINE Link].
American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology. Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol. 2006 Sep. 97(3 Suppl 2):S1-38. [QxMD MEDLINE Link].
Silverberg NB, Pelletier JL, Jacob SE, Schneider LC, SECTION ON DERMATOLOGY, SECTION ON ALLERGY AND IMMUNOLOGY. Nickel Allergic Contact Dermatitis: Identification, Treatment, and Prevention. Pediatrics. 2020 May. 145 (5):[QxMD MEDLINE Link].
Şengul Emeksiz Z, Özmen S. The case of a child with contact urticaria due to sodium benzoate treatment. Contact Dermatitis. 2021 Jun 17. [QxMD MEDLINE Link].
Sobowale K, Clayton A, Smith MV. Diaper Need Is Associated with Pediatric Care Use: An Analysis of a Nationally Representative Sample of Parents of Young Children. J Pediatr. 2021 Mar. 230:146-151. [QxMD MEDLINE Link].
Anıl H, Harmancı K. Evaluation of contact sensitivity to food additives in children with atopic dermatitis. Postepy Dermatol Alergol. 2020 Jun. 37 (3):390-395. [QxMD MEDLINE Link].

Media Gallery

Dry, fissured, pruritic eczema is frequently the result of excessive washing and very low humidity in cold climates. Irritant contact dermatitis is due to direct injury of the skin. In this patient, frequent handwashing and use of soap is the cause of damage to the protective layers of the upper epidermis. Patients should be educated about the cause of the dermatitis and instructed in methods of skin protection and care with emollients.
Nickel is the most frequent contact allergen in females older than 8 years, and allergy occurs in as many as 25% of females 14 years or older. Allergens, such as nickel, are impossible to completely avoid. Exposure can be reduced with careful instruction, but occult exposures may produce chronic or recurrent symptoms. Nickel in the watch and watch band produced this episode of allergic contact dermatitis.
Allergic reactions to rubber products are usually caused by antioxidants and accelerators added in the manufacturing process, rather than the rubber itself. Antioxidants help preserve the rubber, and accelerators help in the vulcanization process. Exposure to rubber in gloves, shoes, undergarments, tires, heavy-duty rubber goods, and sport goggles is common.
The typical eruption from poison ivy includes erythema, edema, papules, vesicles, and bullae. Linear streaks as in this patient are characteristic but are not always present. Initial yellow crusts are dried serum from ruptured bullous lesions and not evidence of infection. Oleoresin (urushiol), which exudes from damaged areas of poison ivy, poison oak, and poison sumac, turns black after exposure to air. Fresh oleoresin on the skin dries and may be observed as black smudges or spots.
When limes are squeezed into beverages, excess juice remains on the skin. Many other foods can cause similar reactions, i.e. the phytophotodermatitis. Sun exposure of this lime juice produces areas of dermatitis or hyperpigmentation. Perfumes are also common sources of photo contact dermatitis.
Most common moisturizers contain various additives and preservatives. The list of ingredients on this bottle is not uncommon, and most of these agents are capable of causing allergic contact dermatitis. Patch testing with dilute concentrations of the individual ingredients can be used to identify the agent that is a problem for any particular patient.
Areas of acute contact dermatitis respond well to cool compresses and wound care. Moist compresses are soothing, have a mild antipruritic effect, reduce serous drainage, and gently debride the wound. Clean water, isotonic sodium chloride solution, and Burow solution all can be used. Compresses should be kept moist at all times. Wet-to-dry compresses are painful and destroy fragile tissues. Following moist compress applications for 5-10 minutes, affected sites should be gently cleared of loose crusts and a thin coat of Vaseline or antibacterial ointment should be applied.
Urticaria, also known as hives or whelps, involves edematous pale or pink plaques. Agents can produce urticaria by immunologic reactions, by nonimmunologic reactions, or by unknown mechanisms. Nonimmunologic reactions are most common. Other types of environmentally associated urticaria must be excluded. This is an example of cold urticaria produced by application of an ice cube to the dorsum of the arm.
Prolonged use of moderate- to high-potency topical steroids may cause skin atrophy or steroid acne. This patient used a moderate-strength steroid, triamcinolone 0.1%, in this area for several weeks. Steroid acne, also called steroid rosacea, has a classic appearance with monomorphic erythematous papules. If the steroid is discontinued, the condition usually worsens. Patients must understand that symptoms worsen before they improve, and several weeks or months are required to taper off this steroid.
This purpuric reaction was noted after application of eutectic mixture of local anesthetics (EMLA) for 1 hour. EMLA cream is widely used as a local anesthetic for superficial procedures. Blanching and redness are commonly observed side effects. Dramatic purpuric reactions to EMLA, as in this patient, have been reported. Patch test results in these patients with the individual ingredients of EMLA cream, EMLA cream itself, placebo cream, and Tegaderm are negative. Apparently, the purpuric reaction is not of an allergic nature, but the cream may have a toxic effect on the capillary endothelium.

of 10

Author

Nanette B Silverberg, MD Clinical Professor of Dermatology, Icahn School of Medicine at Mount Sinai; Chief of Pediatric Dermatology, Mt Sinai Health Systems, Mount Sinai St Luke's-Roosevelt Hospital and Mt Sinai Beth Israel Medical Centers

Nanette B Silverberg, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Academy of Pediatrics, American Association of University Women, American Medical Association, American Medical Women's Association, Dermatology Foundation, European Society for Pediatric Dermatology, Pediatric Dermatology Research Alliance, Phi Beta Kappa, Sigma Xi, The Scientific Research Honor Society, Society for Pediatric Dermatology, Vitiligo Support International, Women's Dermatologic Society

Disclosure: Received income in an amount equal to or greater than $250 from: Valeant Pharmaceuticals.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association

Disclosure: Nothing to disclose.

Acknowledgements

Mark A Crowe, MD Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine

Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society

Disclosure: Nothing to disclose.

Pediatric Contact Dermatitis Questions & Answers

References

Tables

Contributor Information and Disclosures

What would you like to print?