EXPERT ANALYSIS FROM NOAH 57
ASHEVILLE, N.C. (FRONTLINE MEDICAL NEWS) – “Children really do develop contact dermatitis, and they are frequently mislabeled as cases of eczema,” Dr. Bruce Brod said at the annual meeting of the Noah Worcester Dermatological Society.
When taking a history in a child with potential contact dermatitis, keep the most likely allergens in mind, especially nickel, said Dr. Brod of the University of Pennsylvania, Philadelphia. Nickel remains the most common allergen in adults and young children, and more than a quarter of patients are positive on patch testing.
Consider all possible sources of nickel. In addition to the old standbys of jewelry and buckles, ask patients and families about the use of flip-style cell phones, as well as first generation iPads (the cases contained nickel). “Old cell phones do not make great toys,” Dr. Brod emphasized.
Patch testing children with potential contact dermatitis makes sense in several situations, including cases of new-onset dermatitis; progressing or deteriorating dermatitis; involvement of specific body sites, such as the face, eyelids, or neck folds; an increase in the total body surface area affected; clinical presentation of dyshidrosis; and dermatitis that resists standard therapies and only improves with oral or extremely potent topical steroids, he said.
Children with atopic dermatitis are more prone to irritation from patch testing, so shorten the exposure time and use a lower concentration of allergens such as nickel, formaldehyde, and rubber additives, advised Dr. Brod. Shorten the exposure time for children younger than 5 years of age, whether or not they have atopy, he added. Videos or video games can work well as a distraction.
When taking a history, consider the most the common allergens in children, defined in a recent study of patch testing results ( Dermatitis 2014;25:345-55 ), said Dr. Brod. He offered the mnemonic MAFLPP (More Allergies for Lovable Pediatric Patients) to characterize the top categories: metals (nickel and cobalt), antibiotics (neomycin and bacitracin), fragrance (fragrances and balsam of Peru), lanolin, phenylenediamine, and preservatives (including quatemium-15 and methylisothiazolinone).
After patch testing, describe the allergen to patients and their families, and explain where it is found, Dr. Brod said. The site mypatchlink.com has helpful information. Also remind patients to read product labels, and to check pharmacy websites such as drugstore.com or cvs.com.
Members of the American Contact Dermatitis Society can access the Contact Allergen Management Program (CAMP) database to help patients identify allergen-free products based on their patch test results, he said.
Dr. Brod had no relevant financial conflicts to disclose.