Definition

• Red itchy area of the skin from contact with an allergic substance

Health Information

Symptoms

• The rash is always very itchy
• Rash on one small part of the body (localized)
• Usually starts as raised red spots. It can change to blisters.

Causes

• Skin contact with an allergic substance.
• The location of the rash may suggest the cause:
• Poison ivy or oak. Exposed areas, such as the hands.
• Nickel (metal). Anywhere the metal has touched the skin. (Neck from necklaces, earlobe from earrings, or fingers from rings. Stomach from metal snap inside pants, wrist from watch, or face from eyeglass frames.)
• Tanning agents in leather. Tops of the feet from shoes or hands from leather gloves.
• Preservatives in creams, lotions, cosmetics, sunscreens, shampoos: where applied
• Neomycin in antibiotic ointment: where applied

Allergic Contact Dermatitis From Creams or Ointments

• Any of the creams below can cause an itchy rash where it is applied:
• Antibiotic ointments or creams
• Anesthetic ointments or creams (such as numbing creams)
• Sunscreens
• Insect repellents
• Cosmetics (such as deodorants)
• Preservatives or fragrances found in any ointment, cream or lotion (such as moisturizing creams)

Nickel Contact Dermatitis

• Overview: Over 10% of adults have an allergy to metals that have nickel in them. Some children develop it. Nickel is often present in cheaper jewelry.
• Symptoms. People with nickel allergy get an itchy rash where the metal touches their skin. (Neck from necklaces, earlobe from earrings, or fingers from rings. Stomach from metal snap inside pants, wrist from watch, or face from eyeglass frames.)
• Diagnosis. See your doctor if you are not sure nickel is causing the rash.
• Treatment. Apply a small amount of hydrocortisone cream to the red-itchy area. Do this 3 times a day for 7 days.
• What to Expect. Once you stop wearing the nickel jewelry, the rash slowly goes away. The redness and itching should go away in 7-14 days.
• Prevention. Avoid jewelry that has nickel in it.
• AVOID: Nickel is PRESENT in white gold and yellow gold (12-Karat or less). Most stainless steel is 12% nickel. Also, avoid silver colored “fashion or costume” jewelry.
• SAFE: Nickel is ABSENT in 18-Karat (or higher) yellow gold. You can also look for nickel-free 14-Karat yellow gold. Sterling silver, copper, titanium or platinum jewelry is safe. Nickel-free stainless steel is also available.

Prevention of Contact Dermatitis

• Learn the cause of your contact dermatitis. Then try to avoid contact with it.

Care Advice

1. Overview:
   • Most new localized rashes are due to skin contact with something.
   • If the rash is very itchy, it’s often from an allergic substance.
   • Here is some care advice that should help.
2. Avoid the Cause:
   • Try to find the cause and avoid it.
   • Review the list of causes for contact dermatitis.
   • A pet may carry the irritant, as with poison ivy or oak. Also, some children react directly to pet saliva.
3. Do Not Use Soap:
   • Wash the red area once with soap. Reason: To remove any irritants left on the skin.
   • Then, do not use soaps on it. Reason: soaps can slow healing.
   • Cleanse the area when needed with warm water.
4. Cold Pack:
   • Use a cold wet washcloth or soak in cold water for 20 minutes.
   • Do this every 3 to 4 hours as needed. This will help with itching or pain.
5. Steroid Cream (OTC):
   • If the itch is more than mild, put 1% hydrocortisone cream on the rash.
   • No prescription is needed. (OTC)
   • Use it 3 times per day.
   • Exception: Do not use for suspected ringworm.
6. Steroid Cream (Prescription):
   • Most contact dermatitis needs a stronger steroid cream to control itching.
   • Your doctor will decide. If prescribed, use the cream as directed.
7. Allergy Medicine-Benadryl:
   • If itching persists, give Benadryl by mouth.
   • Use every 6 hours as needed.
   • No prescription is needed.
8. Try Not to Scratch:
   • Help your child not to scratch the rash.
   • Cut the fingernails short.
9. What to Expect:
   • Most often, the rash lasts 2-3 weeks.
   • Treatment can reduce the severity of symptoms.
   • Treatment does not change how long they last.
10. Return to School:
    • Your child does not need to miss any child care or school.

Call Your Doctor If

• Rash spreads or gets worse
• Rash lasts for more than 3 weeks
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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