12-year-old boy complains of irritated skin near his auricles

topical corticosteroid therapy

Educational Objective:

Describe the presentation and management of contact dermatitis.

Explanation:

Contact dermatitis arises from prolonged or recurrent contact with a physical, chemical, or mechanical irritant. Contact dermatitis is determined by a thorough history and physical examination. In the case of this child, a new pair of eyeglasses has resulted in linear lesions along his face and around the ear where the frames are in contact with his skin. Typical management includes removal of the stimulant, which, in this case, may need to consist of wearing the old pair of glasses and exchaning the new pair for soemthing made from a different material. Treatment with a topical corticosteroid should provide temporary relief.

The need for systemic steroid therapy is excessive given the focal and limited nature of the symptom presentation. Antihistamine therapy would provide little relief, because the cause is not based on an allergic mechanism.

Nickel in the frames of glasses and on the back of jewerly commonly triggers an allergic reaction that results in eczema. The reaction is worsened by the fact that nickel dissolves and is absorbed in microscopic amounts when the person sweats. By contrast, gold, silver, titanium, and iron (!) rarely react because bodily fluids do not dissolve them.

Reference:

Dickey BZ, Chiu YE. Eczematous disorders. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 20th ed., 2015:3150-3155.