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?
Allergic Contact Dermatitis
• 1. Itchy rash due to your skin coming in direct contact with an allergen
2. Allergic contact dermatitis requires PRIORsensitization
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
Very different from PRICK testing which is by the Allergist and evaluates for Type 1 allergies
(food, pollen, dust, cats, dogs, mold, etc)
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%
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