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Authors: Dr Gia Toan Tang; A/Prof Rosemary L Nixon, Occupational Dermatology Research and Education Centre, Skin Health Institute, Melbourne, VIC, Australia. Medical Editor: Dr Helen Gordon, Auckland, New Zealand. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. September 2020.
Allergic contact dermatitis is common in children because their skin can be easily sensitised. Compared to adults:
Sensitisation mainly occurs in newborns and infants aged 0–3 years, and the prevalence of subsequent allergic contact dermatitis increases with age .
Allergic contact dermatitis in children
Common allergens that trigger allergic contact dermatitis in children include:
The relevant allergens in children vary with age. For example, allergic contact dermatitis caused by nickel is more common in adolescents than in newborns, as older children acquire piercings and wear jewellery and belts .
The clinical presentation of allergic contact dermatitis in children is similar to that in adults.
Rare morphologies, such as erythema multiforme, pigmented purpuric eruption, and pustular or granulomatous reaction patterns, are unlikely to occur in children because exposure to the allergens associated with these particular presentations is unlikely (eg, tropical woods, rubber diving suits) .
Allergic contact dermatitis is suspected clinically and is confirmed by patch testing. Patches containing the test substances are applied to the back for 48 hours, and the tests are assessed 48–96 hours later to identify the culprit allergen(s) . Recently, the Australian Paediatric Baseline Series of 30 allergens was proposed, as compared to the larger Australian Baseline Series of 60 allergens .
Patch testing in children has a reasonable positive predictive value [2,7]. However, there may be false positives and false negatives [7,8]. It can be difficult to discriminate between irritation caused by the tested substances and weak allergic positive patch tests .
As in adults, other conditions that can look similar to allergic contact dermatitis should be considered in children. These can include the following.
The most important aspect of management is to identify the causative allergen. This may be obvious from the history or it may be necessary to perform patch testing.
Allergic contact dermatitis has been reported to result in psychological effects in carers as well as in the affected child, inducing anxiety and depression. Therefore, psychological support should also be considered .
Counselling regarding allergen avoidance strategies is essential.
As with adults, once sensitised, contact allergy may persist, so skin contact with culprit allergens should be avoided lifelong .
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