Allergic contact dermatitis in children: which factors are relevant? (review of the literature).
Allergic contact dermatitis (ACD) in children is increasing. Sensitization to contact allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects and intense or repetitive contact with allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined dermatitis on the lower legs. Clinical polymorphism of contact dermatitis to clothing may cause difficulties in diagnosing textile dermatitis. Toys are another potentially source of hapten exposure in children, especially from toy-cosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact allergens in children are metals, fragrances, preservatives, neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant eczema are encountered. Children should be patch-tested with a selection of allergens having the highest proportion of positive, relevant patch test reactions. The allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or therapy-resistant eczema in children.
Department of Dermatology, Erasmus MC University Medical Center Rotterdam and KinderHaven Havenziekenhuis, Rotterdam, The Netherlands. f.dewaard@erasmusmc.nl
Flora B
FB
de Waard-van der Spek
Klaus E
KE
Andersen
Ulf
U
Darsow
Charlotte G
CG
Mortz
David
D
Orton
Margitta
M
Worm
Antonella
A
Muraro
Peter
P
Schmid-Grendelmeier
Ramon
R
Grimalt
Radoslaw
R
Spiewak
Odilija
O
Rudzeviciene
Carsten
C
Flohr
Susanne
S
Halken
Alessandro
A
Fiocchi
Luis M
LM
Borrego
Arnold P
AP
Oranje
D000293:Adolescent; D000485:Allergens / Q000009:adverse effects / Q000276:immunology; D000818:Animals; D002648:Child; D002675:Child, Preschool; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D004485:Eczema / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D004781:Environmental Exposure / Q000009:adverse effects; D006801:Humans; D007114:Immunization; D007223:Infant; D008670:Metals / Q000009:adverse effects / Q000276:immunology; D016273:Occupational Exposure / Q000009:adverse effects; D012008:Recurrence; D012882:Skin Tests
D000485:Allergens; D008670:Metals