Prevalence and risk factors for allergic contact dermatitis to topical treatment in atopic dermatitis: a study in 641 children.
BACKGROUND
There is little information regarding the risk of sensitization associated with topical atopic dermatitis (AD) treatment.


OBJECTIVE
To assess the frequency of sensitization to topical treatment of AD in children and to determine risk factors associated with skin sensitization.


METHODS
Six hundred and forty-one children with AD were systematically patch tested with seven agents of common topical treatment: chlorhexidine, hexamidine, budesonide, tixocortol pivalate, bufexamac, sodium fusidate and with the current emollient used by the child. The following variables were recorded: age, sex, age at onset of AD, associated asthma, severity of AD, and history of previous exposure to topical agents used in the treatment of AD. Skin prick tests to inhalant and food allergens were used to explore the IgE-mediated sensitization.


RESULTS
Forty-one positive patch tests were found in 40 patients (6.2%). Allergens were emollients (47.5%), chlorhexidine (42.5%), hexamidine (7.5%), tixocortol pivalate and bufexamac (2.5% each). Risk factors associated with sensitization to AD treatment were AD severity [OR: 3.3; 95% confidence interval (CI):1.5-7.1 for moderate to severe AD], AD onset before the age of 6 months (OR: 2.7; 95% CI: 1.2-6.1), and IgE-mediated sensitization (OR: 2.5; 95% CI: 1.1-5.9).


CONCLUSIONS
Topical treatment of AD is associated with cutaneous sensitization. Antiseptics and emollients represent the most frequent sensitizers and may be included in the standard series in AD children when contact dermatitis is suspected. Risk factors associated with sensitization to AD topical treatments are AD severity, early AD onset and IgE-mediated sensitization.
Mailhol
C
C
Paul Sabatier University and Department of Dermatology, Purpan Hospital, Toulouse, France.
Lauwers-Cances
V
V
Rancé
F
F
Paul
C
C
Giordano-Labadie
F
F
D000287:Administration, Topical; D000485:Allergens / Q000276:immunology; D018926:Anti-Allergic Agents / Q000009:adverse effects / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017449:Dermatitis, Allergic Contact / Q000453:epidemiology* / Q000209:etiology* / Q000276:immunology; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D004643:Emollients / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors
D000485:Allergens; D018926:Anti-Allergic Agents; D000890:Anti-Infective Agents; D004643:Emollients