What Is Contact Dermatitis?

As a pediatrician, the most common form of irritation of the skin that I see is atopic dermatitis. However, the next most common form of skin irritation I see is contact dermatitis.

Both are common types of eczema that cause skin inflammation, itching, and rashes.

What Is Contact Dermatitis?

It is a skin condition that develops when a chemical or physical material comes into contact with the skin and can make it red and itchy. If something chronically irritates the skin, it can become thickened, fissured, and scaly.

Symptoms Of Contact Dermatitis

Some of the common symptoms of contact Dermatitis that you notice on the skin are:

• Dry skin
• Itchy skin
• Crusty, flaky skin
• Hives
• Burning sensation
• Oozing blisters
• Bumpy rashes
• Skin discoloration
• Skin tightness.

What causes contact dermatitis?

Contact dermatitis is caused when the skin comes in contact with allergens and irritants. When the skin comes in contact with the irritant it is known as irritant contact dermatitis, the immune system releases proinflammatory cytokines from keratinocytes which causes skin barrier dysfunction.

This phenomenon causes the skin to lose moisture more easily and the outside bacteria and viruses to penetrate the skin. Whereas in allergic contact dermatitis, when the skin is repeatedly exposed to a certain allergen the immune system releases T-cells, these T-cells produce different chemicals that may cause antigen-specific inflammation and lead to swelling, redness, and irritation of the skin. This process is called sensitization. 

When the skin comes in contact with that particular allergen once again in the future, the T-cells are reactivated causing a visible uncomfortable reaction on the skin. 

Types Of Contact Dermatitis

As described above, contact dermatitis comes in two flavors—Irritant Contact Dermatitis and Allergic Contact Dermatitis. As I am a pediatrician, I will focus on common causes of contact dermatitis that I see in the pediatric population, as this is a very common type of eczema. When thinking of young children, many begin to think of changing diapers and, therefore, rashes that can accompany the use of diapers.

Irritant Contact Dermatitis

One of the most common diaper rashes is from urine or feces irritating the skin—this is an Irritant Contact Dermatitis (ICD). Some children can also be irritated from the repeated microtrauma of diaper wipes. 

In older children and adolescents, another frequent cause of ICD is hand washing. Everyone is washing their hands more than ever, and fragrance and harsh soaps can really dry out the skin of the entire hand. 

A discussion on kids’ skin irritants is not complete without giving mention to thumb sucking and lip licking as two other common causes of ICD.  If you are experiencing contact dermatitis regularly, keep a safe daily eczema shampoo at home, one that is free from harsh ingredients. Some other irritants that may trigger irritant contact dermatitis are:

• Cleaning products
• Hair dyes
• Paints
• Resin
• Plastic
• Acids 

Allergic Contact Dermatitis

The other type of contact dermatitis, Allergic Contact Dermatitis, (as described earlier) is a little more complicated. One of the most common types of Allergic Contact Dermatitis that I see in my practice is poison ivy. 

In this form of skin irritation, the body comes in contact with a substance like poison ivy and gets “sensitized.” Sensitization means the body mounts a response (makes specific T-cells) to fight against poison ivy without you even knowing it. 

And then it is not until the next pleasant walk through the woods, a week or months later when the offensive plant brushes against your leg or arms, and you get the itchy, red bumps and blisters. 

To be clear, when re-exposed, in this case, to poison ivy, the rash does not appear immediately. The itchy rash develops 3 or 4 days after coming in contact. This is called a “delayed-type hypersensitivity” reaction and is characteristic of Allergic Contact Dermatitis (ACD).

Another common offender that causes ACD is nickel—the metal. I see this less and less as athletic wear like leggings has gained traction in America. Nickel is found in buttons and also in earrings.

So I frequently saw skin rashes below the belly button that would be present on children’s abdomens for months until it was pointed out that the rash may have come from the button holding the jeans around the patient’s waist. Many earrings also have nickel in them, which can cause a chronic rash in the ear lobe.

Some other allergens that trigger allergic contact dermatitis are:

• Fragrances
• Skincare products
• Medications
• Preservatives 

Patch Testing For Allergic Contact Dermatitis

Sometimes, the source of ACD can be obvious, as in the two examples mentioned above, but many times, a “patch test” has to be done by your dermatologist or allergist in order to find the offender. 

Fragrances, rubber (shoes), metals, cosmetic preservatives like parabens, and surfactants (the ingredient that makes shampoo lather) are just some of the ingredients that can cause a problem.

Your doctor may place these allergens in a small patch on your body to find out which one is causing the reaction. This helps in avoiding the allergen and managing contact dermatitis.

Contact Dermatitis Treatment

The most important factor in managing these causes of skin irritation is eliminating the offending particle and moisturizing the skin.  

• Diaper Care

If diaper rash is present, then temporarily eliminating diaper wipes and using a gentle non-soap cleanser and water and patting dry will help. Try changing the baby’s diaper as soon as possible when it gets spoiled.

• Choose The Right Products

Easier said than done when It comes to eliminating lip licking and thumb sucking, but when it comes to excessive hand washing, switching to a gentle, non-soap cleanser that avoids harsh surfactants is crucial. Happy Cappy Daily Body Wash is a product that uses nonabrasive surfactants that are sulfate-free and pH-balanced.

• Avoiding The Triggers

Avoiding poison ivy will take long-sleeved shirts and pants and diligence in learning how to identify the plant. Regarding nickel, athleisure (and less wearing of jeans) is a good thing. If the ear lobes are getting irritated, examine what the earrings are composed of and aim for 100% gold earrings.

• Moisturizing

Using an irritant-free moisturizing eczema cream at least twice daily that does not have parabens or fragrance, like Happy Cappy Moisturizing Cream, will help protect the skin barrier, drawing moisture into the skin (glycerin) and reduce further water loss from the skin by coating it an emollient (petrolatum). Happy Cappy has the added benefit of having a redness-soothing natural ingredient, Licorice Root Extract.

If the skin is still irritated, then a doctor’s consultation is advised, as steroids or another prescription anti-inflammatory is needed to manage contact dermatitis.

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Dr. Eddie Valenzuela

Dr. Eddie Valenzuela is an award winning pediatrician and the founder and CEO of Pediatric Solutions, LLC.

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