Pediatric contact dermatitis: what's new

Analysis of patch test results in 716 pediatric patients with type IV hypersensitivity dermatosis

OBJECTIVE

This study presents a comprehensive analysis of patch test results in a cohort of 716 pediatric patients diagnosed with type IV hypersensitivity dermatosis. The aim is to provide valuable insights for the prevention and treatment of type IV hypersensitivity dermatosis in the pediatric population.

METHODS

A prospective study was conducted from August 2021 to October 2023, enrolling pediatric patients with type IV hypersensitivity dermatosis attending the Department of Dermatology at the prestigious Air Force Medical Center. The patients were categorized into four distinct age groups based on World Health Organization guidelines: infants and young children (under 3 years), preschoolers (ages 3 to 5), school-age children (ages 6 to 11), and adolescents (ages 12 to 14). Patch testing was performed using a pediatric series of allergens, and the distribution patterns of allergens were meticulously analyzed based on the test results. Furthermore, variations in patch test positivity rates and allergen positivity rates were evaluated across different genders and age groups.

RESULTS

Out of the 716 patients included in the study, the overall patch test positivity rate was found to be 86.87%. The top five allergens identified were textile dye mix, limonene hydroperoxide, nickel sulfate, cobalt chloride, and benzoyl peroxide. A comparative analysis of patch test positivity rates between males and females revealed no significant difference (87.85% vs. 86.19%, χ2 = 0.439, P > 0.05). Similarly, there was no statistically significant variation observed in the patch test positivity rates among the top three dermatoses, including eczema, facial dermatitis, and allergic contact dermatitis (ACD) (χ2 = 6.39, P > 0.05). Notably, within the top 10 allergens, textile dye mix, benzoyl peroxide, disperse blue 106/124, and potassium dichromate exhibited higher positivity rates in males (38.14%, 25.99%, 25.14%, and 13.56%, respectively) compared to females (29.56%, 18.23%, 17.40%, and 7.18%, respectively). Conversely, the positivity rate of cobalt chloride was higher in females (28.18%) than in males (19.49%). These gender-based differences were statistically significant (P < 0.05). In terms of age groups, there was no significant disparity observed in the overall patch test positivity rates (χ2 = 3.26, P > 0.05). However, when analyzing the top five allergens, namely textile dye mix, nickel sulfate, and cobalt chloride, distinct variations in positivity rates were discerned among different age groups (P < 0.05). For the specific case of ACD, sensitivity: 82.6%, specificity: 57.1%, false positive rate (FPR): 42.9% .

CONCLUSION

This study elucidates the primary allergens implicated in type IV hypersensitivity dermatosis among pediatric patients visiting our dermatology outpatient clinic, namely textile dye mix, limonene hydroperoxide, nickel sulfate, cobalt chloride, and benzoyl peroxide. Additionally, it highlights the influence of gender on the positivity rates of common allergens, such as textile dye mix, benzoyl peroxide, disperse blue 106/124, potassium dichromate, and cobalt chloride. Furthermore, age-related variations were noted in the positivity rates of textile dye mix, nickel sulfate, and cobalt chloride.

[Inflammatory dermatoses in children and adolescents : Diagnosis and treatment of atopic dermatitis and psoriasis]

Atopic dermatitis (AD) and psoriasis belong to the most common inflammatory dermatoses that we treat in everyday clinical practice. AD manifests in more than 70% of cases before the age of 5 years. Approximately one-third of psoriasis patients report on onset of disease in the first two decades of life. Here, we are going to review both disorders in the light of pediatric dermatology. We are going to discuss selected subtypes and present clues for further examination with respect to the differential diagnoses and comorbidities. The article provides insight into current therapeutic developments that are relevant for the treatment of children and adolescents.

Allergic Contact Dermatitis in Pediatric Practice

BACKGROUND

Allergic contact dermatitis (ACD) is prevalent among pediatric population, adolescent and young adults. Patients with ACD experience a lot of sociopsychological and qualityof- life (QoL) difficulties. Children and their caregivers alike are vulnerable to the burden of ACD.

OBJECTIVES

We have, in this paper, provided an overview of ACD and discussed common and unusual causes of ACD.

METHODS

We performed an up-to-date literature review in the English language on "allergic contact dermatitis" via PubMed Clinical Queries, using the keywords "allergic contact dermatitis" in August 2022. The search included meta-analyses, randomized controlled trials, clinical trials, casecontrol studies, cohort studies, observational studies, clinical guidelines, case series, case reports, and reviews. The search was restricted to English literature and children.

RESULTS

ACD may be acute or chronic and it affects more than 20% of children and adults with significant quality-of-life impairments. ACD is manifested by varying degrees of cutaneous edema, vesiculation, and erythema. The hypersensitivity reaction is one of the most prevalent forms of immunotoxicity in humans. Localized acute ACD lesions can be managed with high-potency topical steroids; if ACD is severe or extensive, systemic corticosteroid therapy is often required to provide relief within 24 hours. In patients with more severe dermatitis, oral prednisone should be tapered over 2-3 weeks. Rapid discontinuation of corticosteroids can result in rebound dermatitis. Patch testing should be performed if treatment fails and the specific allergen or diagnosis remains unknown.

CONCLUSION

ACD is common and can be a physically, psychologically, and economically burdensome disease. Diagnosis of ACD is primarily based on history (exposure to an allergen) and physical examination (morphology and location of the eruption). Skin patch test can help determine the causative allergen. Allergen avoidance is the cornerstone of management. Topical mid- or highpotency corticosteroids are the mainstay of treatment for lesions on less than 20% of the body area. Severe cases of ACD may require treatment with systemic corticosteroids.

Results of the patch tests with European baseline series in children: Five years of experience from a single center in Turkey and a review of the literature

BACKGROUND

Pediatric allergic contact dermatitis (ACD) is increasingly prevalent. Patch testing is the gold-standard diagnostic method.

AIMS

Our study aimed to identify common contact-sensitizing allergens in Turkish children.

PATIENTS/METHODS

We retrospectively analyzed the patch test results and characteristics of 191 pediatric patients [114 (59.7%) females, 77 (40.3%) males], who received the diagnosis of allergic contact dermatitis between 2015 and 2019.

RESULTS

The mean age of the patients was 12.2 years (range 4-18 years). Thirty-six (18.8%) of the patients in the study group had positive patch test outcomes with 56 positive allergens. Girls had a significantly higher rate of total positive patch test results than boys (75%/25%; p = 0.003, p < 0.05). The most frequent four allergens were nickel sulfate (n = 20, 10.4%), cobalt chloride (n = 6, 3.14%), p-phenylenediamine (n = 5, 2.61%), Methylchloroisothiazolinone/methylisothiazolinone (n = 5, 2.61%), respectively.

CONCLUSIONS

In our study, we discovered that in addition to the frequently encountered metal allergens such as nickel and cobalt, p-phenylenediamine and Methylchloroisothiazolinone/methylisothiazolinone sensitivities were frequent in the Turkish population. p-phenylenediamine sensitization can cause serious systemic dermatitis during the lifetime of children. We suggest that in Turkey personal care and hygiene products containing Methylchloroisothiazolinone/methylisothiazolinone should be legally regulated. Since childhood contact dermatitis may have an impact on the quality of life by influencing family and social life, suspected allergens should be detected as early as possible.

What We Have Learned–Milestones in Pediatric Contact Dermatitis

Purpose of Review

This review highlights recent developments in the field of pediatric allergic contact dermatitis (ACD) and patch testing. We will review updates on the pathophysiology of contact dermatitis, discuss new contact allergens, explore the impact of dupilumab on patch testing, and provide pearls for the diagnosis and management of ACD in children.

Recent Findings

ACD is not a single immunologic phenomenon but rather has contributions from multiple inflammatory pathways. Emerging contact allergens include ingredients found in “slime” toys, glucose monitors and insulin pumps, and electronic equipment. Data thus far suggests that patch testing results are generally reliable in the face of concurrent dupilumab use.

Summary

ACD is likely underrecognized and underdiagnosed in pediatric patients, including infants and young children. Providers should keep patient-specific factors and emerging trends in mind when addressing suspected ACD, consider contact dermatitis when they encounter challenging cases of atypical, refractory, or chronic dermatitis, and feel comfortable performing patch testing in children.

Contact allergy to and allergic contact dermatitis from formaldehyde and -releasers: A clinical review and update

This review aims to provide a clinically useful update regarding the role of formaldehyde (FA) and its five main releasers (FRs) quaternium-15, diazolidinyl urea, DMDM hydantoin, imidazolidinyl urea and 2-bromo-2-nitropropane-1,3-diol (bronopol) in contact allergy and allergic contact dermatitis. These ubiquitous preservatives are still often, and sometimes undeclared, present in cosmetics, pharmaceuticals, medical devices, household detergents and chemical (industrial) products. In Europe, the use of free FA and quaternium-15 in cosmetics is forbidden and contact allergy rates have been found to be stable to decreasing. However, FA/FRs still readily provoke localized (e.g., facial/hand), airborne and generalized dermatitis, and may also complicate atopic and stasis dermatitis, or result in nummular dermatitis. Seborrheic-, rosacea- and impetigo-like dermatitis have recently been reported. For a correct diagnosis, FA 2% aq. (0.60 mg/cm² ) should be used, and particularly the FRs bronopol 0.5% pet. and diazolidinyl urea 2% should be patch tested separately in a baseline series. If sensitization to FA occurs, both FA and FRs should preferably be avoided, except perhaps for bronopol in case it tests negatively. If a patient reacts to one or more FRs (such as bronopol, or diazolidinyl/imidazolidinyl urea), but not to FA, then the specific FR(s) should be avoided. This article is protected by copyright. All rights reserved.

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

BACKGROUND

Contact allergy is increasingly recognized as being important in children with eczema.

OBJECTIVES

To retrospectively analyse the patch test results in children over the past 10 years, aiming to (1) evaluate demographic characteristics and lesion locations, (2) describe frequencies of positive patch test reactions, and (3) investigate the relationship with atopic dermatitis (AD).

METHODS

A total of 329 children were patch tested between January 2010 and December 2019 with the European (children) baseline series and/or other series, and the personal product(s) used.

RESULTS

A total of 119 (36%) children presented with at least one positive reaction. Children with AD had a higher prevalence of positive reactions compared with the non-AD group (P = .002), but without statistically significant difference regarding sensitization to more than one hapten (P = .39). The face (20.2%), hands (19.3%), feet (16.8%), arms (12.6%), and body folds (10.9%) were the most common sites of primary localizations. The most frequent contact allergens were nickel sulfate and linalool hydroperoxide (both 16%), limonene hydroperoxide (13.5%), and para-phenylenediamine (10.9%). No statistically significant difference for nickel sulfate was found between the AD and non-AD group (P = .20).

CONCLUSIONS

Contact allergy in children with eczema was frequently observed in our tertiary referral centre in Belgium as well, confirming the need for patch testing.

Age-related differences in patch testing results among children: Analysis of North American Contact Dermatitis Group Data, 2001-2018

BACKGROUND

An updated understanding of allergic contact dermatitis is needed, particularly in children.

OBJECTIVES

To compare positive and clinically relevant reactions in children versus adults referred for patch testing.

METHODS

Retrospective analysis of 1871 children and 41,699 adults from the North American Contact Dermatitis Group (NACDG) from 2001-2018.

RESULTS

Both final diagnosis of allergic contact dermatitis (55.2% versus 57.3%; chi square, P = .0716) and prevalence of ≥ 1 currently relevant reaction to a NACDG screening allergen (49.2% vs 52.2%; P = .1178) were similar between children and adults. Currently in children, the most common relevant allergens were nickel sulfate (17.3%), hydroperoxides of linalool (7.8%), methylisothiazolinone (7.7%), cobalt chloride (7.0%), and fragrance mix I (4.9%). Approximately a fifth of children had a positive reaction to a non-NACDG allergen.

CONCLUSION

Over half of children referred for patch testing were diagnosed with allergic contact dermatitis. The most common relevant allergens in children were nickel sulfate, cobalt chloride, and hydroperoxides of linalool. Twenty percent of children had at least 1 positive reaction to allergens/substances not on the NACDG screening series, underscoring the need for comprehensive testing.

Pediatric Allergic Contact Dermatitis

Allergic contact dermatitis (ACD) affects up to 20% of adults and children, although children are infrequently patch tested. Available data suggest that children and adults, with or without atopic dermatitis, have the same prevalence of ACD. Patch testing is the gold standard for evaluation of ACD. The Pediatric Baseline Series was recently published by expert consensus for use in pediatric patch testing, with additional allergens tested as guided by history. This article examines methods of patch testing and up-to-date data on pediatric ACD. The top allergens are reviewed, and avoidance strategies are discussed.

Isothiazolinones Common in Children's Toy Slime

BACKGROUND

Contact dermatitis to homemade slime has been frequently reported, with isothiazolinones as a likely sensitizer. Little is known on the presence of these preservatives in commercial, store-bought slime products.

OBJECTIVES

The aims of the study were to review the literature on "slime dermatitis" and to assess for the presence of isothiazolinones in commercially available slime products and homemade slime components.

METHODS

An experimental, colorimetric spot test was used to verify the presence of isothiazolinones in 38 slime products of the 16 best-selling commercial slime kits, 1 finished homemade slime, and 4 common components of homemade slime. High-performance liquid chromatography with UV detection was performed on 8 commercial slime products.

RESULTS

According to the spot test, 27 (71%) of the 38 commercial slime products contained isothiazolinones. High-performance liquid chromatography with UV detection analyses indicated, however, that false-positives and false-negatives readily occur: isothiazolinone content was correctly identified in only 4 (50%) of the 8 samples.

CONCLUSIONS

This study is the first to demonstrate the presence of isothiazolinones in commercial slime toys. Although the colorimetric spot test may have some utility as a screening assay, it is far from specific and likely not sensitive enough to reliably identify methylisothiazolinone.

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

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.