Contact Dermatitis in Childhood

The session 'Contact dermatitis in childhood' was presented by Vincent A Deleo from St Luke's Roosevelt and Beth Israel Medical Centers (NY, USA). Contact dermatitis, by definition, is a cutaneous disease caused by skin contact with exogenous chemicals resulting in eczema or dermatitis, with only 20% of reactions being true T-cell-mediated allergic reactions.

Eczema in children is most commonly associated with atopy. Contact dermatitis is the cause of 20% of childhood dermatitis. From 2001 to 2004, 391 children versus 9670 adults were referred for patch testing for contact allergy according to the North American Contact Dermatitis Group (NACDG). Out of those referred, 40% of children (vs 17% of adults) were found to have atopic eczema, 66% of children (vs 68% of adults) had a positive patch test and 51% of children had a clinically relevant patch test (vs 54% of adults).^[8] Reactions were positive to nickel 28% of the time, and were clinically relevant 26% of the time.

Patch testing in childhood may be performed as early as infancy. However, patch testing in childhood is relatively uncommon, with only approximately 4% of patch tests carried out by the NACDG in patients less than 18 years of age.

There are currently a number of testing trays, including the Thin-layer Rapid Use Epicutaneous (TRUE®) test, the syringe-based American series, supplemental series like the NACDG series, and more directed testing series depending on the location of the patient's dermatitis and their history. Patients may also be tested to their own personal products.

The differential diagnosis of contact dermatitis in childhood includes: atopic eczema, hand dermatitis, seborrheic/perioral dermatitis, tinea manum/pedis, palmoplantar psoriasis, nummular dermatitis and erythroderma.