Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children

Abstract

Allergic contact dermatitis (ACD), a delayed hypersensitivity skin reaction to environmental allergens, has a prevalence that is similar in children and adults. However, diagnostic testing for ACD in pediatric populations accounts for less than one tenth of all patch tests. The relative infrequency of pediatric patch testing may be attributed to the difficulty in testing in this population, which includes a smaller surface area for patch test placement and maintaining cooperation during patch testing, especially in younger children. Diagnosis can be difficult in children because the appearance of ACD can mimic other common pediatric skin conditions, particularly atopic dermatitis and irritant contact dermatitis. Comprehensive history taking, guided by patient presentation, age group, and location of dermatitis, helps build clinical suspicion. Such clinical suspicion is one of the major reasons behind patch testing, with additional indications being recalcitrant dermatitis and dermatitis with atypical distribution. US pediatric data have shown the top allergens to be metals, fragrances, topical antibiotics, preservatives, and emollients. These trends are important to recognize to guide management and accurate diagnosis, because ACD tends to persist if the allergen is not identified and can affect patients' quality of life.

Contact allergy in a paediatric population observed in a tertiary referral centre in Belgium

“…The most frequent primary locations of ACD in our study group were roughly those body areas generally clinically suspected of ACD in children. 21 By contrast, it has already been shown that primary dermatitis sites in them cannot predict the diagnosis of ACD, 22 therefore any child with persistent or atypical eczema should be referred for patch testing regardless of the affected primary locations.…”

“…The ten most frequent contact allergens observed in our population (Table 2) are consistent with the literature in this regard, being metals, fragrances, PPD, ingredients of topical pharmaceutical products and cosmetics, and Compositae plants. 12 Nickel sulfate is the most frequently reported allergen in children worldwide, 21 despite the EU Nickel Directive since 2001, 23 possibly because of nickel-containing toys imported from non-European countries that do not have to comply with these restrictions. 12 wipes), essential oils, diffusers, scented candles, and incense.…”

“…12 wipes), essential oils, diffusers, scented candles, and incense. 21,24 Contact dermatitis due to PPD is common in teenagers, 12 the main exposure sources being hair dyes and black henna tattoos. 25 In our study group there were no children with a positive test result to PPD under the age of 9 years, and for PTD not even under the age of 15.…”

“…Other frequent allergens were fragrances (fragrance mixes, linalool, and limonene hydroperoxides), being obviously omnipresent in the daily life of children. Frequent sources are perfumes, cosmetics even commercialized as toys, personal care products (including shampoo and [wet] wipes), essential oils, diffusers, scented candles, and incense 21,24 …”

Consort Allergic Contact Dermatitis: A Systematic Review

“…Unusual cases included systemic contact dermatitis from chromium in breastmilk due to excessive consumption of chocolate by the mother 53 and facial dermatitis after being kissed by a grandfather who had gargled mercurochrome mouthwash 54 . Despite the significant burden of ACD in this population, patch testing is underperformed in pediatric patients 55 ; this may contribute to a delayed diagnosis of CACD in children compared with adult patients.…”