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. This is where 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.

What are the causes of contact dermatitis?

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 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.

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 on a regular basis it may be wise to keep a safe daily eczema shampoo at home, one that is careful to avoid harsh ingredients.

The other type of contact dermatitis, Allergic Contact Dermatitis, 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 poison ivy without you even knowing it. And then it is not until the next jovial walk through the woods, a week or months later, when the offensive plant brushes against your leg or arms that 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. It is 3 or 4 days after coming in contact that the itchy rash develops. 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, and so I used to frequently see 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 and can cause a chronic rash in the ear lobe.

Patch Testing in 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, surfactants (the ingredient that makes shampoo lather), are just some of the ingredients that can cause a problem.

Managing Contact Dermatitis

The most important factor in managing these causes of skin irritation is eliminating the offending particle and moisturizing the skin.  If diaper rash is present, then temporarily eliminating diaper wipes and using a gentle non-soap cleanser and water and patting dry will help.

Easier said then 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 cleanse that avoids harsh surfactants is crucial. Happy Cappy Daily Body Wash is one such product that uses nonabrasive surfactants that are sulfate-free and pH balanced.

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

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, draw water into the skin (glycerin), and reduce further water loss from the skin by coating it an emollient (petrolatum). Happy Cappy has an added benefit of having redness soothing natural ingredient Licorice Root Extract.

If the skin is still irritated, then a doctor consultation is advised as steroids or another prescription anti-inflammatory may be in order.

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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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