Dec 12, 2019
Dermatologists often are the first to notice allergic contact
dermatitis exposure patterns in the pediatric population. Vincent
DeLeo, MD, talks with Dr. Margo Reeder, Dr. Amber Reck Atwater,
and Jennifer M. Tran about
patch test practices in children for the diagnosis of ACD.
Because children have unique product and environmental exposures,
panels should be customized based on the patient’s exposure
history. “Not only is ACD prevalent in children but also that the
allergen profile is unique when compared to adults,” advises Dr.
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Things you will learn in this episode:
- Two studies – the North American Contact Dermatitis Group and
the Pediatric Contact Dermatitis Registry – have shown positive
patch test reactions in children at rates of 57% and 48%,
- Improve patch testing your pediatric patients by learning about
nuances such as their unique exposures and how to work with the
smaller surface area of their skin.
- Take a thorough history by asking parents to “walk through a
day in the life of their child” to uncover exposures from personal
care products, topical medications, hobbies, and any individuals
who interact with them. “It’s where you truly have to bring out
your inner Sherlock Holmes to determine what and where potential
allergens are,” Ms. Tran advises.
- Common allergens found in the pediatric population include
nickel, cobalt, neomycin, balsam of Peru, lanolin, fragrance mix I,
and propylene glycol.
- Reassure worried children about patch testing by providing
education and using distraction techniques. “We have photos,
including photos of kids undergoing patch testing that we can show
before we apply the patches just to show them exactly what’s going
to happen,” Dr. Reeder says. “Distraction is important too.”
- Currently, three pediatric patch test screening series are
available: T.R.U.E. Test, North American Pediatric Patch Test
Series, and Pediatric Baseline Patch Test Series.
Consult the Table online for information on these forms of patch
- Allergen exposure can occur from sports equipment, jewelry,
braces, keys, zippers, school chairs, electronics, and toys.
“Musical instruments have also been implicated in contact
dermatitis in children,” Dr. Atwater adds, “and believe it or not,
toilet seat dermatitis has also been reported.”
- Consider patch testing in atopic dermatitis when the patient’s
dermatitis has changed, is significantly different, or involves new
areas of the skin.
Guests: Margo Reeder,
MD (department of dermatology, University of Wisconsin,
Amber Reck Atwater, MD; (department of dermatology, Duke
University, Durham, N.C.); Jennifer M. Tran (department of
dermatology, University of Wisconsin, Madison)
Show notes by Jason Orszt, Melissa Sears, Elizabeth
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