A Girl’s Polyurethane-Induced Contact Dermatitis: Burn-Like Injury From a Tablet Computer Cover

Amirtha V. Chinnadurai, MD, and Peace Ibekwe, MD

A 12-year-old girl presented to the emergency department with a burning rash on her left forearm that had begun 2 hours before. The child had noticed an insidious burning sensation and had seen redness of the skin over her forearm. No other lesions or concurrent symptoms were noted. She was afebrile. There was no history of trauma or burns.

On physical examination, a 7 × 3-cm, nontender area of erythematous, well demarcated, rectangular, macular, urticarial lesions was noted on the girl’s left arm (Figure 1). The cutaneous findings were consistent with a first-degree burn. No evidence of nonaccidental trauma was noted. She was sent home with supportive care.

The girl presented a second time 12 hours later, because the rash on her left forearm had worsened. This time, the plaque was more erythematous and was warm to the touch but was still nonpruritic (Figure 2). Concurrently, a new smaller nonpruritic erythematous patch was developing on her right anterior forearm. She remained afebrile. Her erythrocyte sedimentation rate and the results of blood cultures, a complete blood count, and C-reactive protein testing were all unremarkable, except for eosinophilia at 6.5%. Diphenhydramine was administered and the patient discharged.

Several hours later, the patient presented again with continued progression of the rash (Figure 3). All other examination findings were unremarkable. At this point, the parent suspected that the culprit was the girl’s iPad, given that the location and the shape of the lesions were consistent with the way the child cradled the device. The tablet had a removable simulated-leather polyurethane cover.

The girl’s lesions healed after 5 days. She was seen for follow-up 2 weeks later, at which time scars were noted on both forearms. Square-shaped hyperpigmented and and hypopigmented postinflammatory scars had developed on the right anterior forearm, while the left anterior forearm had an oblong scar (Figure 4).


Dermatologic complications, particularly contact dermatitis, have been associated with increasing exposure to portable electronics such as laptop computers, smartphones, and tablets.1,3 Jacob and Admani, for example, recently reported a case of generalized dermatitis secondary to nickel sensitization from exposure to an iPad.1 Our patient had a rare case of irritant contact dermatitis linked to exposure to polyurethane, the main component of the simulated-leather iPad cover.

Our patient’s rash, which was associated with significant pain and a burning sensation, occurred in multiple stages. The initial urticarial lesion progressively became bullous and was followed by hyperpigmentation, a pattern similar to that seen with chemical burn injuries. These findings are consistent with irritant contact dermatitis. Unlike allergic contact dermatitis, which is a cell-mediated immune response, irritant dermatitis occurs secondary to direct cytotoxic exposure to the offending agent.2

Cases of contact dermatitis have been related to exposure to strong agents such as acidic or alkaline solvents, or to weaker agents such as soaps, detergents, and other solvents.2 Contact dermatitis cases commonly are related to occupational hazards, but cases increasingly have been noted among children. In our case, polyurethane is implicated as the cause of the patient’s contact dermatitis, given the history of exposure to the iPad’s cover and the specific shape of the lesions.

Polyurethanes are chemicals that are produced by the reaction of isocyanates, mostly toluene diisocyanate and polyethers.4,5 Polyurethanes are commonly used in foam rubber, synthetic fibers, surface coatings, glues, and sealants.4

The number of reported cases of contact dermatitis from polyurethane has been increasing due to increased exposure. Goossens and colleagues reported 22 cases of polyurethane contact dermatitis between 1978 and 2001 in Belgium.5 Turan and colleagues in Turkey described a 10-year-old girl’s case of contact dermatitis caused by exposure to a polyurethane toilet seat.4 Based on our expanded literature search, ours is the first reported of cases of contact dermatitis reported from an exposure to the case of an iPad.

Amirtha V. Chinnadurai, MD, is chief resident in the Department of Pediatrics at Columbia University Medical Center, the Affiliation at Harlem Hospital Center in New York, New York.

Peace Ibekwe, MD, is an attending physician in the pediatric emergency department at Columbia University Medical Center, the Affiliation at Harlem Hospital Center in New York, New York.


1. Jacob SE, Admani S. iPad—increasing nickel exposure in children. Pediatrics. 2014;13(2):e580-e582.

2. Sasseville D. Occupational contact dermatitis. Allergy Asthma Clin Immunol. 2008;4(2):59-65.

3. Jensen P, Jellesen MS, Møller P. Nickel allergy and dermatitis following use of a laptop computer. J Am Acad Dermatol. 2012;67(4):e170-e171.

4. Turan H, Saricaoğlu H, Turan A, Tunali S. Polyurethane toilet seat contact dermatitis. Pediatr Dermatol. 2011;28(6):731-732.

5. Goossens A, Detienne T, Bruze M. Occupational allergic contact dermatitis caused by isocyanates. Contact Dermatitis. 2002;47(5):304-308