Contact Dermatitis – Can a Child have Eczema and this?

Double whammy? Contact dermatitis in atopic dermatitis child

Double whammy? Contact dermatitis in atopic dermatitis child

Can my Child have both Atopic and Contact Dermatitis?

Contact dermatitis is more common in adults, but it is possible that a patient with atopic dermatitis also have contact dermatitis. The logic is that eczema skin barrier is defective, thus more vulnerable to hypersensitive reaction to chemicals. The chemicals which I’ve found from recent years’ studies which affect eczema patients (not necessarily children) more than non-eczema patients are

Surfactants cocamidopropyl betaine (CAPB), from AAD study. Also quaternium-15, imidazolidinyl urea, DMDM hydantoin, and 2-bromo-2-nitropropane-1,3-diol (from another AAD study)

How does dermatologist treat Contact Dermatitis?

The treatment is similar to atopic dermatitis, so in a sense it may not be as critical if the two cannot be differentiated. The difference is that without avoiding the substance that is causing the hypersensitive reaction, it is then not possible to keep it from causing the rash. Moisturizing, medicated cream, compresses to relieve itch and soothe skin, and antihistamines for reduced scratching at night may be prescribed.

In finding out which are the irritants involved in contact dermatitis, a patch test can be carried out (read more here). Patch test involves placing the suspected irritants/chemicals (note: there is a ‘science’ as to how much to put and how to prepare the liquid, don’t try to do this yourself) on paper tape on your child’s back or arm. The tape will be left on for about 48 hours and observation be noted by the dermatologist.

Is my child more likely to have contact dermatitis as an adult?

I haven’t come across such study, but it makes sense to figure out the irritants early and to avoid them. Also to treat the eczema promptly and take measure to protect the child’s skin barrier so that it is more robust against irritants when the child is older. (At the same time, I’m thinking she has got to fend for herself when old, I’m not going to say ‘Stop Scratching’ till I’m 60 year old!)

What are the preventive measures for contact dermatitis?

Avoidance is key, especially once you or your child has undergone patch testing and knows which substance triggers the hypersensitive reaction. There are common chemicals that are present in contact dermatitis in children (US), and these are nickel, neomycin, cobalt, fragrance, Myroxylon pereirae, gold, formaldehyde, lanolin/wool alcohols, thimerosal, and potassium dichromate. Also for those without any allergy, but has eczema (known as ‘intrinsic eczema’), this study suggest the possibility of nickel and cobalt allergy.

This study provides a percentage of common allergens for eczema children, nickel (16.3%), cobalt (6.9%), Kathon CG (5.4%), potassium dichromate (5.1%), fragrance mix (4.3%), and neomycin (4.3%).

The above chemical names may be too difficult to remember, so below is a compilation of where they may be commonly present in:

Soaps and detergents

Saliva

Urine (common cause of diaper rash)

Baby lotions, avoid perfume/fragrance products, preservatives

Latex, e.g. rubber products

We’ve covered the basics and the conclusion may be to be aware of contact dermatitis and promptly remove the suspected irritants. When the child is older, say 5 year old, bring him/her to a patch test.

Read last week: Contact Dermatitis, does your Eczema Child have it?

Facial Eczema with Dr Lynn Chiam: Rashes around the Mouth and Lips

Dr Lynn Chiam, a consultant dermatologist who subspecializes in paediatric skin conditions

This is a series focused on facial eczema, with the privilege of having Dr Lynn Chiam, of of Children & Adult Skin Hair Laser Clinic, to help explain further the type of facial rashes, its treatment options and daily facial care. Dr Lynn is a consultant dermatologist who subspecializes in paediatric skin conditions at Mount Elizabeth Novena Specialist Medical Centre, Singapore. Apart from paediatric dermatology, her other subspecialty interests include adult pigmentary conditions and laser dermatology. More on Dr Lynn can be found here.

Why is the area around my mouth and my lips red and itchy?

This week’s focus is on another prominent part of the face – the mouth and the lips. Apart from being prominent and noticeable as one will look inevitably look at someone’s mouth when he/she is talking, the lips is also an area that comes into contact with the food we eat, lip balm, lip stick and to some extent, toothpaste! This post will be in the form of Q&A, kindly assisted by Dr Lynn.

Question 1 – Clarifying the type of rash: What sort of rash is common around the mouth? And is the same common on the lips? What is allergic contact cheilitis?

Dr Lynn: Some of the common rashes which can occur around the mouth include

  1. Facial eczema. This happens in individuals with eczema and facial eczema is more common in infants.
  2. Perioral dermatitis consists of groups of itchy or tender small red papules (bumps) which appear most often around the mouth. They spare the skin bordering the lips but develop on the sides of the chin, then spreading to include upper lip and cheeks. The surrounding skin may be pink, and the skin surface often becomes dry and flaky. Perioral dermatitis can be caused by the overuse of steroid creams, moisturizers, make-up and sunscreen. It is important to see your doctor as a course of oral antibiotics is needed.
  3. Cheilitis is inflammation of the lips. It can cause deeps cracks at the sides of the lips which can be painful. There are many causes of cheilitis and they include: eczematous cheilitis, contact cheilitis (reaction to substances like make-up etc), medications and nutritional deficiencies. Allergic contact cheilitis is allergic contact dermatitis affecting the lips. It is an immune reaction of the body towards a substance to which the individual is allergic. Lip cosmetics, toothpaste, medication and dental materials are the most common cause of allergic contact cheilitis.

Question 2 – Identifying the Allergen/ Irritant: What can one try to isolate the product or food that is causing the rashes? For instance, should one note if a rash occurs after shaving, brushing teeth or ingesting certain food? What is the appropriate allergy testing?

Dr Lynn: The appropriate test is the patch test. A patch test is a method used to determine if a substance is responsible for causing an allergic inflammation of the skin. Diluted amounts of the substances are placed in contact with the skin on the back. If the individual is truly allergic to the substance, a local reaction will occur on the skin. Testing should include the standard series of test allergens as well as any other materials suggested by the history (like lip cosmetics, toothpaste). If you notice that a particular facial or dental product or food causes a rash around the lips consistently, do inform your doctor and include it into the patch test.

Question 3 – Food versus Contact Allergens: Is there a difference in the time lag between an allergic reaction triggered by contact, say with a musical instrument, or a cosmetic/skincare product versus food?

Dr Lynn: Allergic contact dermatitis triggered by contact with a musical instrument or cosmetic/skincare product is an itchy skin condition caused by an allergic reaction to a substance in the product. It arises some hours after contact with the responsible material, and settles down over some days provided the skin is no longer in contact with the skin. Contact dermatitis should be distinguished from contact urticaria, in which hives appears within minutes of exposure and fades away within minutes to hours.

Likewise, food allergy can present with immediate reactions occurring within minutes after ingestion like swelling of the lips, hives and in more severe cases, difficulty breathing. It can also present few hours later and can cause late reaction like eczematous rash.

Question 4 – Treatment: What is the treatment available for lips? Can steroid be applied?

Dr Lynn: If the lips are involved in contact dermatitis or eczema, a low potency steroid or a topical calcineurin-inhibitor like Pimecrolimus or Tacrolimus can be applied. As the skin on the lips is thinner and absorbs more cream compared to similar sized-skin on other areas on the body, only low potency steroid creams should be used for a limited amount of time.

Thanks Dr Lynn for helping us learn lots about facial eczema this month!

For previous posts in this series, see

Facial Skin Rash – What Rashes on Face (part 1 and part 2)

Facial Skin Rash – Rosacea and Psoriasis

What Treatment to put on Face

Rashes on Eyelids

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