Allergic contact dermatitis in pediatric practice

Kam Lun Hon; Alexander K C Leung; James Wesley Cheng; David C K Luk; Agnes Sy Leung; Mark J Koh

doi:10.2174/1573396320666230626122135

Allergic contact dermatitis in pediatric practice

Curr Pediatr Rev. 2023 Jun 26. doi: 10.2174/1573396320666230626122135. Online ahead of print.

Authors

Kam Lun Hon¹, Alexander K C Leung², James Wesley Cheng³, David C K Luk³, Agnes Sy Leung⁴, Mark J Koh⁵

Affiliations

¹ Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong.
² Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada.
³ Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong.
⁴ Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
⁵ KK Women's and Children's Hospital, National University of Singapore.

PMID: 37365784
DOI: 10.2174/1573396320666230626122135

Abstract

Background: Allergic contact dermatitis (ACD) is prevalent among pediatric population, adolescent and young adults. Patients with ACD experience a lot of sociopsychological and quality-of-life (QoL) difficulties. Children and their caregivers alike are vulnerable to the burden of ACD.

Objective: We have, in this paper, provided an overview of ACD and discussed common and unusual causes of ACD.

Methods: We performed an up-to-date literature review in the English language on "allergic contact dermatitis" via PubMed Clinical Queries, using the keywords "allergic contact dermatitis" in August 2022. The search included meta-analyses, randomized controlled trials, clinical trials, case-control studies, cohort studies, observational studies, clinical guidelines, case series, case reports, and reviews. The search was restricted to English literature and children.

Results: ACD may be acute or chronic and it affects more than 20% of children and adults with significant quality-of-life impairments. ACD is manifested by varying degrees of cutaneous edema, vesiculation, and erythema. The hypersensitivity reaction is one of the most prevalent forms of immunotoxicity in humans. Localized acute ACD lesions can be managed with high-potency topical steroids; if ACD is severe or extensive, systemic corticosteroid therapy is often required to provide relief within 24 hours. In patients with more severe dermatitis, oral prednisone should be tapered over 2-3 weeks. Rapid discontinuation of corticosteroids can result in rebound dermatitis. Patch testing should be performed if treatment fails and the specific allergen or diagnosis remains unknown.

Conclusion: ACD is common and can be a physically, psychologically, and economically burdensome disease. Diagnosis of ACD is primarily based on history (exposure to an allergen) and physical examination (morphology and location of the eruption). Skin patch test can help determine the causative allergen. Allergen avoidance is the cornerstone of management. Topical mid- or high-potency corticosteroids are the mainstay of treatment for lesions on less than 20% of the body area. Severe cases of ACD may require treatment with systemic corticosteroids.

Keywords: allergen; allergic contact dermatitis; burdensome disease; life quality; patch test; type IV delayed hypersensitivity.