Irritant Contact Dermatitis
Irritant contact dermatitis (ICD) is direct damage to the skin barrier from repeated contact with an irritant, without any allergy. Irritants strip oils and natural moisturising factor from the outer skin faster than it can repair, so further irritants get in and trigger inflammation (DermNet). In young children it is most common on the face, the backs of the hands and the nappy area. It is driven by repeated wetting and drying and by body fluids such as drool, saliva from lip-licking, urine and faeces, as well as soaps and acidic foods (Siegfried & Hebert 2015; Napolitano 2022). Toddlers with Atopic Dermatitis are more susceptible because their barrier is already weak. DermNet notes that anyone exposed enough will get ICD, but people with atopic dermatitis are “particularly susceptible”.
Irritant Contact Dermatitis [relates] Skin Barrier Dysfunction Atopic Dermatitis [worsens] Irritant Contact Dermatitis Irritant Contact Dermatitis [part-of] Differential Diagnosis of Toddler Eczema
Toddler forms. The chronic, cumulative type of ICD is the one seen in young children. It starts as dryness and cracking and progresses to redness and itch (DermNet). The typical examples are Nappy Rash (napkin dermatitis), Drool Dermatitis in teething infants, Lip-Licker’s Dermatitis in older toddlers, and mealtime rashes around the mouth from acidic foods. Bath products and soap (Sodium Lauryl Sulfate) and residues of Laundry Detergents or fragrance in clothing add to the load (Allergy UK). ICD usually stays confined to the contact site, and burning or stinging is often more prominent than itch (DermNet). A shape that matches a nappy, a bib or the reach of the tongue is the clue. The rash also often clears when the irritant is removed.
Drool Dermatitis [part-of] Irritant Contact Dermatitis Sodium Lauryl Sulfate [causes] Irritant Contact Dermatitis
Diagnosis and relation to allergy. There is no test for ICD. Diagnosis rests on the history and the pattern of the rash (DermNet). Patch Testing is used only when Allergic Contact Dermatitis is suspected, and the two can co-exist. Complications include spread of eczema to other sites, Lichenification and secondary infection (Infected Eczema). On darker skin, redness can be hard to see and Post-Inflammatory Hyperpigmentation commonly follows (DermNet).
Allergic Contact Dermatitis [relates] Irritant Contact Dermatitis Irritant Contact Dermatitis [causes] Post-Inflammatory Hyperpigmentation
Management. Treatment means avoiding the irritant, using frequent emollients and Barrier Creams or ointments, and, if needed, a short course of mild topical steroid (DermNet; Siegfried & Hebert 2015). Topical Calcineurin Inhibitors are an alternative on the face. In practice: frequent nappy changes with barrier ointment, wiping drool and food off gently and then applying a bland Petrolatum barrier before meals, and using Soap Substitutes instead of soap. Chronic ICD can be slow to settle without consistent care (DermNet).
Barrier Creams [prevents] Irritant Contact Dermatitis Soap Substitutes [prevents] Irritant Contact Dermatitis
Connections
- Nappy Rash — commonest form of nappy rash, source: DermNet 2017
- Lip-Licker’s Dermatitis — saliva-driven ICD of the lips, source: DermNet 2020
- Laundry Detergents — surfactant/perfume residue in clothing as irritant, source: Allergy UK
- Drool Dermatitis — saliva ICD in teething infants (“dribble rash”), source: DermNet ICD
- Allergic Contact Dermatitis — differential; may co-exist; patch testing separates them, source: DermNet ICD
- Atopic Dermatitis — atopic skin particularly susceptible, source: DermNet ICD
- Post-Inflammatory Hyperpigmentation — common after ICD in darker skin, source: DermNet ICD