Pediatric Allergic Contact Dermatitis: Patch Testing, Atopic Dermatitis, and Common Allergens

Conclusions

• Allergic contact dermatitis appears to be common in children and is likely under-recognized because kids are referred for patch testing far less often than adults.
• Children who are evaluated for patch testing have positive reaction rates that are similar to adults, so pediatric contact dermatitis should be taken seriously rather than assumed to be only atopic dermatitis.
• Atopic dermatitis and allergic contact dermatitis frequently overlap, and children with worse or more extensive AD are at increased risk of also having ACD.
• Patch testing is most useful in children with recalcitrant eczema, unusual distribution, sudden worsening, or new-onset eczema in older children.
• Using larger or more comprehensive allergen series improves detection of relevant allergens, but the choice of series must be balanced against the child’s available skin surface.
• Patch testing can be done safely in children, including many children receiving dupilumab, and testing should often proceed without stopping that therapy.
• Avoiding identified allergens can meaningfully improve many children’s eczema, sometimes completely, showing that a substantial portion of their dermatitis may be due to ACD rather than AD alone.
• Common pediatric allergens include metals, fragrances, preservatives, topical medications, and surfactants, which are often found in everyday products and treatments used on children.
• The session’s overall message is that clinicians should have a lower threshold to suspect and evaluate allergic contact dermatitis in children with eczema.