Allergic contact dermatitis in children: which factors are relevant? (review of the literature)

Abstract

Allergic Contact Dermatitis (ACD) in children is increasing. Sensitization to contact allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects and intense or repetitive contact with allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined dermatitis on the lower legs. Clinical polymorphism of contact dermatitis to clothing may cause difficulties in diagnosing textile dermatitis. Toys are another potentially source of hapten exposure in children, especially from toycosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact allergens in children are metals, fragrances, preservatives, neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant eczema are encountered. Children should be patch-tested with a selection of allergens having the highest proportion of positive, relevant patch test reactions. The allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or therapyresistant eczema in children.Allergic contact dermatitis (ACD) in children is increasing (1). Sensitization to contact allergens may already begin at an early age. The data on prevalence of contact allergy among children visiting dermatology clinics vary between 15% and 71% (2-5). Patch testing is the gold standard diagnostic test (6, 7).

Patch test results in children and adolescents across Europe. Analysis of the ESSCA Network 2002–2010

“…As regards the prevalence of at least a positive reaction to a hapten of the EBS, in our study population, we found virtually no difference between children with AD and children without. This finding is in accordance with other studies . Nickel sensitization is often caused by piercing, which bypasses the epidermal barrier presumably impaired in AD.…”

Contact dermatitis

“…19 Women are more likely to be diagnosed with contact dermatitis than men. [19][20][21] Allergic contact dermatitis is not uncommon in children and is on the rise. 22 Having atopic eczema, increases the risk of irritant contact dermatitis because of impaired skin barrier function.…”

Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications

“…Impaired skin barrier function has been a suspected risk factor but results of studies have been conflicting and risk may be allergen-specific [17,18,19,20]. Recognition of CD in the setting of coexisting skin disease requires a high index of suspicion based on personal/family history, presence of xerosis, and, if necessary, results of “patch testing” (although the sensitivity of patch testing is less than 70%).…”