Irritant Contact Dermatitis

Medscape

29-05-2025

A 13-year-old girl presented to the pediatric office with a 1-day history of a rapidly progressive rash affecting her face and hands (Figure 1). Initially, she thought it might be related to eating dried mangoes the day before, although she had consumed mango in the past without any issues. She had been seen at urgent care and was started on oral prednisone, but the rash continued to worsen and eventually began peeling, which prompted referral to pediatric dermatology (Figure 2).
Figure 1
During her clinic visit, the patient mentioned that she had recently begun using a new skincare product she purchased from a popular beauty store at the mall. She was following a skincare routine she had seen promoted by social media influencers. Her personal medical history was significant for mild atopic dermatitis, well-controlled with triamcinolone ointment used intermittently on her antecubital fossae, and a background of ichthyosis vulgaris.
Figure 2
She was not experiencing systemic symptoms such as fever or malaise and reported no recent use of new oral medications. On physical examination, she had erythematous, scaly plaques on her face and hands with notable peeling. There was no lymphadenopathy. Other findings included hyperlinear palms and fine scaling on the lower extremities, consistent with her ichthyosis.
Discussion
Given the rapid onset of symptoms and their the limited distribution, and the lack of response to systemic steroids, a diagnosis of severe irritant contact dermatitis secondary to the patient's new skincare product was made. The product contained retinol and salicylic acid — both known to be potent, irritating ingredients, particularly in individuals with a compromised skin barrier. Children with ichthyosis and atopic dermatitis are particularly vulnerable to such reactions because their skin barrier is thinner, more permeable, and more reactive to environmental exposures.
Catalina Matiz, MD
I share this case to highlight a growing trend we are now seeing in young preteens, especially girls, developing increasingly elaborate skincare routines, often centered around antiaging and acne-prevention regimens that were never intended for pediatric use. Social media has glamorized these routines, popularizing the term 'Sephora kids' and even coining the nonmedical term ' dermorexia ' to describe compulsive skincare behaviors. Although they are often brushed off as harmless or cute, these routines carry real dermatologic consequences, especially in children with barrier-defective skin.
Many of the products marketed for antiaging contain retinoids, beta-hydroxy acids such as salicylic acid, and a host of preservatives, perfumes, and botanicals that can easily irritate or sensitize pediatric skin. The skin of a child is not just smaller; it is biologically different. The stratum corneum is thinner, transepidermal water loss is higher, and the developing lipid matrix is more vulnerable to disruption. These physiologic factors, combined with the overuse of adult-formulated actives, create a perfect storm for irritant and allergic reactions.
In this particular case, allergic contact dermatitis was also considered. It is possible that the patient had a type IV hypersensitivity reaction to one or more ingredients in the product. However, allergic contact dermatitis typically presents 48-96 hours after exposure and is often dominated by pruritus. This patient's reaction occurred in less than 24 hours and was described more as painful and burning than itchy. Furthermore, allergic contact dermatitis generally improves with systemic or topical corticosteroids, while this patient continued to worsen even on oral prednisone.
SSSS was also in the differential diagnosis, but the absence of widespread desquamation involving flexural areas, lack of systemic symptoms, and the distribution limited to the face and hands made this diagnosis unlikely. SSSS, caused by an exotoxin from Staphylococcus aureus , targets desmoglein-1 and leads to superficial epidermal splitting. It is typically treated with systemic antibiotics such as cephalosporins or oxacillin.
DRESS was also briefly considered because it can present with facial swelling and skin peeling. However, the absence of fever, lymphadenopathy, and a history of recent medication exposure made this diagnosis unlikely as well.
The patient was ultimately treated with gentle skincare, including a nonfoaming cleanser, a thick, fragrance-free emollient, and a low-potency topical corticosteroid. No further systemic medications were needed, and she recovered well.
As pediatricians and dermatologists, we must be aware of the cultural and digital landscape influencing our patients. Many children and adolescents are following trends promoted by influencers who lack medical knowledge and often recommend products with ingredients far too aggressive for young skin. In a child with no underlying dermatologic history, these regimens can still cause harm, but in a child with atopic dermatitis, ichthyosis, or a compromised barrier for any reason, the effects can be much more severe.
We need to take the time to talk to our patients and their parents about safe skincare. These conversations should be framed with empathy and respect. Many of these children are not trying to damage their skin but to belong, be accepted, or emulate what they see online. Instead of dismissing their interest, we should guide it. We can explain that they don't need wrinkle creams or exfoliating acids, and that good skincare at their age includes gentle cleansers, barrier-protecting moisturizers, and sunscreen — perhaps the best antiaging product of all. And in cases where skincare obsession becomes compulsive or distressing, referral to a mental health professional may be appropriate to evaluate for underlying concerns such as body dysmorphic disorder.
Ultimately, our role is to protect our patients — not just from pathogens and inflammation but also from the quiet damage that can come from misinformation, unrealistic beauty standards, and skin products that promise too much to people too young.