Allergic contact dermatitis is often missed in pediatric patients who present with eczema-like skin eruptions, in part because less is known about ACD in children than in adults.

“Often when we see a child with dermatitis, we automatically think of atopic dermatitis, but we should also consider the possibility of allergic contact dermatitis,” Dr. Joseph F. Fowler Jr. said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

A 2012 cohort study of 349 children between 0 and 15 years indicated that even very young children who were patch tested for common allergens had at least one positive result. Investigators found that nearly three-quarters of children studied tested positive for at least one allergen, typically nickel, other metals, fragrance, or preservatives (Dermatitis. 2012 Nov-Dec;23[6]:275-80).

“This is very similar to what we see in the adult population,” said Dr. Fowler, clinical professor of dermatology at the University of Louisville (Ky.). “Other studies in recent years have borne this out.”

Dr. Fowler suggested having a high degree of suspicion for ACD, especially when pediatric patients present with:

•  Chronic, difficult to control atopic condition, as this could indicate a systemic reaction.

•  Localized or facial dermatitis, as this could indicate the point of contact with an allergen.

•  Scattered, generalized dermatitis, which also could represent systemic allergic contact dermatitis.

•  Dermatitis that worsens, despite otherwise adequate treatment regimen.

•  Reactions following contact with metals, fragrances, topical components, such as preservatives or neomycin.

“In these situations, patch testing will help determine that an allergen is implicated,” Dr. Fowler said.

In children with eczema, Dr. Fowler recommended patch testing when the eczema is not in the typical areas such as behind the knees or elbows, or if it started in typical areas and then spread elsewhere, especially in children around 5 years old.

“The moral of the story is that kids can be allergic to the same things as adults, even though we have less about this in the literature,” Dr. Fowler. “Skin testing or blood testing for food allergies, unless very strongly positive, usually aren’t helpful in the management of the atopic individual. Patch test more and prick test less.”

Dr. Fowler disclosed a number of relationships with companies in the dermatology space. SDEF and this news organization are owned by the same parent company.

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