Live Blog: Pediatric Contact Dermatitis— It’s not all Atopic. Faculty: Sharon Jacob, MD
In this live blog from the Annual Fall SDPA Conference in Orlando, FL, Sharon Jacob, MD, presented a lecture called, “Pediatric Contact Dermatitis— It’s not all Atopic.” Here are some of the highlights.
Dr. Jacob emphasized that, just like adults, children can be exposed to a wide range of contact allergens. Most common irritants are chemicals found in water, soap, and occupational/living sites.
What is the difference between allergic and irritant contact dermatitis? Irritant contact dermatitis is more common because it is not immunologic. To diagnose an irritant, the healthcare provider must inquire about the patient’s history and background. What soaps are they using? What clothes and accessories are they wearing? Allergic contact dermatitis is a delayed hypersensitivity reaction. Patch testing is needed for allergic contact dermatitis testing.
Dr. Jacob argued that patch testing is highly utilized for pediatric patients, but is under reported. Therefore, Jacob is currently working to gather more data on patch testing and children.
Dr. Jacob has been investigating the top ten allergens in U.S. pediatric populations. She reported that nickel is causing a predominant amount of contact dermatitis in pediatric patients, followed by cobalt. Electronic devices (like iPads) contain nickel and are globally prevalent in schools. Dr. Jacob said she has used the top ten allergens list to create a pediatric allergen screening sheet. She uses this screening sheet when she conducts patch tests.
Dr. Jacob will patch test if the patient’s rash is not positively reacting to first approach treatments. In conducting a contact dermatitis screening Dr. Jacob shared useful tips in helping narrow the possible allergen: have parents complete a questionnaire to learn a patient’s basic history (parents are beginning to use more home remedies in the house such as essential oils that children may be allergic to), visit the patient’s home and school to assess the child’s environment, and perform a physical exam. Dr. Jacob noted that there is an additional psychosocial aspect to treating children that demands time management and patience from the healthcare provider.
Dr. Jacob concluded the lecture by sharing several cases of contact dermatitis in pediatric patients, giving conference attendees the opportunity to hypothesis the source and treatment. Some of the child/adult contact dermatitis infections included rubber-based chemicals found in both mouse pads and shin guards, blue dye allergens found in factory uniforms, diaper lining, and black henna tattoo ink.
Dr. Jacob emphasized that once the allergen culprit is discovered, it’s essential to remove it from the patient’s life. “Treatment is avoidance.”