Chapter 30: Dermatitis: Contact Dermatitis (In Children)

Question 1

Contact Dermatitis

Answer 1

can occur if an allergen or skin irritant is encountered

Question 2

Irritant Agents that cause this type of skin sensitivity in children

Answer 2

usually soaps or detergents with fragrances or dyes

• for infants, the diaper area, and could be the result of diaper perfumes, cloth diaper detergents, or diaper wipes
• children playing outdoors may encounter plant life that can cause contact dermatitis; poisonous oaks, ivies, or sumacs
• as children get older and beginning to wear jewelry and watches; may be from specific types of metals (commonly nickel)

Question 3

Diaper Dermatitis

Answer 3

is one form of irritant contact dermatitis

• caused by prolonged exposure to urine and feces
• erythematous, confluent maculopapular rash that is prominent on convex surfaces and in the folds

Question 4

Signs and Symptoms

Answer 4

• irritated, inflamed, and pruritic rash within 48 hours of contact with the offending agent
• vesicles and bullae that may be present in the area
• urticaria (hives) when there is contact with an allergen
• vesicles that may weep serous fluid

Question 5

Diagnosis

Answer 5

• compete history of contacts both in and out of doors

- if a differential diagnosis is required b/c there are atypical lesions, a biopsy may be performed

Question 6

How to determine if allergic contact dermatitis is the diagnosis

Answer 6

patch testing

Question 7

Prevention

Answer 7

• wear long sleeves, long pants, and socks to prevent contact with poisonous plants
• strict avoidance of known allergens in the home, including soaps and fragrances; decrease allergic contact dermatitis
• prevention of irritant contact dermatitis is avoidance of known substances that have resulted in rash and, for infants, frequent changing of diapers

Question 8

Nursing Care

Answer 8

• if weepy lesions, drying agent like an OTC product (Domeboro powder) may bring relief
• pruritic relief, cool baths; longer effect: low dose of OTC hydrocortisone cream can be applied with gloved finger
• oral steroids (prednisolone) only used if more than 10% of child’s body surface area is involved
• a topical agent, Dermoplast, used if discomfort from agents such as poison ivy or oak
• nursing care for diaper dermatitis is aimed at allowing the area to heal in an environment of minimal moisture; frequent diaper changes, area to “air dry”, and use of barrier ointments that include white petrolatum or zinc oxide

Question 9

Medical care

Answer 9

• OTC topical medications used for comfort, and if necessary, may order an anti-pruritic like hydroxyzine (Atarax)
• if greater than 10% of the child’s body is involved, an oral steroid (prednisolone) is common

Question 10

Education/ Discharge

Answer 10

• teach preventative measures
• medication management
• if child is suffering from pruritis, they may require a sedative for sleeping purposes
• sleep aid medications include: diphenhydramine (Benadryl Allergy [OTC for children over 2 years]) and hydroxyzine (Atarax)
• if an oral steroid (prednisolone) is ordered for inflammation, remind parents that the child must complete the dose in the exact way prescribed
• prednisolone (pediapred) must be taken with food and can cause excessive wakefulness