Contact Dermatitis
Nancy B. Esterly MD1
1 Professor of Dermatology and Pediatrics, Northwestern University Medical School, Chicago, Illinois
Contact dermatitis occurs with moderate frequency in children and adolescents and can become a chronic and puzzling problem if the cause is not discerned. A tremendous spectrum of etiologic agents accounts for the diversity of presentations and, although the specific provocative substance may fail to be identified, it is often possible to make an educated guess as to the agent responsible for the eruption.
Both forms of contact dermatitis, irritant and allergic, are the result of an inflammatory reaction in the skin elicited by material in contact with the skin surface. Morphologically contact dermatitis is most often eczematous; its clinical features are, therefore, erythema, vesiculation and oozing in the acute phase, and scaling, fissuring, lichenification and pigmentary change in the chronic phase. Urticarial, granulomatous, papular, and follicular lesions as well as onycholysis (separation of the nail plate from the nail bed) can also represent reactions to contactants. Certain other features are characteristic of contact dermatitis. Usually the eruption is a localized, well-defined plaque sometimes with angular corners and sharp straight borders that suggest application of an exogenous substance. Flexural areas, face, neck, and dorsum of the hands and feet are the most susceptible sites. Scalp, palms, and soles are generally but not inevitably spared.
