Overview of Allergic Contact Dermatitis in Children

JiaDe (Jeff), MDDirector of Occupational and Contact Dermatitis

Assistant Professor of DermatologyMassachusetts General Hospital/Harvard Medical School

@patchtestyu

Disclosures

My spouse and I have the following relevant financial relationship with a commercial interest

to disclose:

Consultant for EllaOla/Purity Brands

Consultant for National Eczema Association

Consultant for Lucid Dermatology

Overview

• What is allergic contact dermatitis and how is this different from other allergies

• How does allergic contact dermatitis present in children?

• What do kids become allergic to and how do you test for it?

24-72 Hours Later

Allergic Contact Dermatitis

• 1. Itchy rash due to your skin coming in direct contact with an allergen

2. Allergic contact dermatitis requires PRIORsensitization

Type 4 Allergic Reaction = Delayed

Contact Dermatitis Food Allergy

15-30 Minutes Later

Type 1 Allergic Reaction = Immediate

95 asymptomatic children from 6 months-5 years

When to Suspect Allergic Contact Dermatitis

• Recalcitrant eczema despite appropriatetherapy

• Eczema in unusual locations/patterns (eyelids, just the face, tops of the feet)

• Worsening eczema without change in treatment plan (acute on chronic)

• New eczema in older patients without a history of atopic dermatitis

Differentiating between atopic dermatitis (eczema) and allergic contact dermatitis in children is difficult!

20% of children with atopic dermatitis have concomitant allergic contact dermatitis

Methylisothiazolinone

Methylchloroisothiazolinone/Methylisothiazolinone

Patch Testing

• Gold standard for evaluation of allergic contact dermatitis

• 3 day affair!

Monday

Wednesday

Friday

Very different from PRICK testing which is by the Allergist and evaluates for Type 1 allergies

(food, pollen, dust, cats, dogs, mold, etc)

Dermabond

Steri-Strips

Top 3 Allergens in Children

• Nickel

• Methylisothiazolinone

• Fragrances

Nickel

Fragrance Mix 1 and 2

• Fragrance Mix 1- 8 fragrances– Geraniol, cinnamal aldehyde, cinnamyl alcohol,

isoeugenol, eugenol, hydroxycitronellal, a-amyl cinnamaldehyde, oak moss

• Fragrance Mix 2- 6 fragrances– Lyral, citral, farnesol, coumarin, citronellol, a-hexyl

cinnamal

• Fragrance mix 1 + Balsam of Peru pick up 75% of fragrance allergic individuals

• Fragrance mix 2 picks up 15% more• Sensitization rate FM1: 11% and FM2: 4.1%

20

11

Sensitization RateMI: 4.4%MCI/MI: 4.2%

Methylisothiazolinone

Six Children With Allergic Contact Dermatitis to Methylisothiazolinone

in Wet Wipes (Baby Wipes). Mary Wu Chang, Radhika Nakrani;

Pediatrics Feb 2014, 133 (2) e434-e438

Take Home Message

• Allergic contact dermatitis is common in children

• Patch testing is the gold standard for evaluation

• Avoidance is curative