Current Allergy and Asthma Reports

, Volume 12, Issue 6, pp 599–606 | Cite as

Current Strategies in Treating Severe Contact Dermatitis in Pediatric Patients

  • Luz S. Fonacier
  • Marcella R. Aquino
  • Tania Mucci
Pediatric Allergy and Immunology (JM Portnoy and CE Ciaccio, Section Editors)


Allergic contact dermatitis in children is underdiagnosed and undertreated, and its incidence is increasing. Appropriate history taking and the suspicion for allergic contact dermatitis is essential, and patch testing remains the gold standard in diagnosis. Avoidance of the offending allergen, once identified, is the first goal of treatment. Medical therapies include topical corticosteroid and topical immunomodulators. In severe cases, oral corticosteroids or immunomodulators are utilized, although prospective randomized trials for the treatment of this disease in children are lacking. A PubMed literature search was performed to identify publications on allergic contact dermatitis in the pediatric population with the keywords: dermatitis, children, allergic contact dermatitis, pediatrics, contact hypersensitivity, contact allergy, treatment, and management. This review will address the major principles behind the diagnosis and management of this disease in the pediatric population, and highlight useful strategies that may result in improved treatment of this condition.


Allergic contact dermatitis Irritant contact dermatitis Atopic dermatitis Patch test Children Metal allergy Fragrance allergy Neomycin allergy Rubber allergy Plant allergy Diagnosis Treatment Pediatric 


Recently published papers of particular interest have been highlighted as: • Of importance •• Of outstanding importance

  1. 1.
    Bickers DR, Lim HW, Margolis D, et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol. 2006;55(3):490–500.PubMedCrossRefGoogle Scholar
  2. 2.
    Militello G, Jacob SE, Crawford GH. Allergic contact dermatitis in children. Curr Opin Pediatr. 2006;18(4):385–90.PubMedCrossRefGoogle Scholar
  3. 3.
    Jacob SE, Brod B, Crawford GH. Clinically relevant patch test reactions in children–a United States based study. Pediatr Dermatol. 2008;25(5):520–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Sharma VK, Asati DP. Pediatric contact dermatitis. Indian J Dermatol Venereol Leprol. 2010;76(5):514–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Kutting B, Brehler R, Traupe H. Allergic contact dermatitis in children: strategies of prevention and risk management. Eur J Dermatol. 2004;14(2):80–5.PubMedGoogle Scholar
  6. 6.
    Giordano-Labadie F, Rance F, Pellegrin F, Bazex J, Dutau G, Schwarze HP. Frequency of contact allergy in children with atopic dermatitis: results of a prospective study of 137 cases. Contact Dermatitis. 1999;40(4):192–5.PubMedCrossRefGoogle Scholar
  7. 7.
    • Herro EM, Matiz C, Sullivan K, Hamann C, Jacob SE. Frequency of contact allergens in pediatric patients with atopic dermatitis. J Clin Aesthet Dermatol. 2011;4(11):39-41. Retrospective chart review, suggesting that patch testing is indicated in children with moderate-to severe atopic dermatitis. PubMedGoogle Scholar
  8. 8.
    Mortz CG, Lauritsen JM, Bindslev-Jensen C, Andersen KE. Prevalence of atopic dermatitis, asthma, allergic rhinitis, and hand and contact dermatitis in adolescents. The Odense Adolescence Cohort Study on Atopic Diseases and Dermatitis. Br J Dermatol. 2001;144(3):523–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Goebeler M, Trautmann A, Voss A, Brocker EV, Toksoy A, Gillitzer R. Differential and sequential expression of multiple chemokines during elicitation of allergic contact hypersensitivity. Am J Pathol. 2001;158(2):431–40.PubMedCrossRefGoogle Scholar
  10. 10.
    Saint-Mezard P, Berard F, Dubois B, Kaiserlian D, Nicolas JF. The role of CD4+ and CD8+ T cells in contact hypersensitivity and allergic contact dermatitis. Eur J Dermatol. 2004;14(3):131–8.PubMedGoogle Scholar
  11. 11.
    Belhadjali H, Mohamed M, Youssef M, Mandhouj S, Chakroun M, Zili J. Contact sensitization in atopic dermatitis: results of a prospective study of 89 cases in Tunisia. Contact Dermatitis. 2008;58(3):188–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Astner S, Gonzalez E, Cheung AC, et al. Non-invasive evaluation of the kinetics of allergic and irritant contact dermatitis. J Invest Dermatol. 2005;124(2):351–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Brasch J, Burgard J, Sterry W. Common pathogenetic pathways in allergic and irritant contact dermatitis. J Invest Dermatol. 1992;98(2):166–70.PubMedCrossRefGoogle Scholar
  14. 14.
    • Belloni Fortina A, Romano I, Peserico A, Eichenfield LF. Contact sensitization in very young children. J Am Acad Dermatol. 2011;65(4):772-779. 321 children aged 3-36 months underwent patch testing for suspected allergic contact dermatitis. A high prevalence of contact sensitization was found in toddlers younger than 3 years of age. Allergic contact dermatitis should be considered in this population. PubMedCrossRefGoogle Scholar
  15. 15.
    Litvinov IV, Sugathan P, Cohen BA. Recognizing and treating toilet-seat contact dermatitis in children. Pediatrics. 2010;125(2):e419–22.PubMedCrossRefGoogle Scholar
  16. 16.
    Matiz C, Jacob SE. Systemic contact dermatitis in children: how an avoidance diet can make a difference. Pediatr Dermatol. 2011;28(4):368–74.PubMedCrossRefGoogle Scholar
  17. 17.
    Seidenari S, Giusti F, Pepe P, Mantovani L. Contact sensitization in 1094 children undergoing patch testing over a 7-year period. Pediatr Dermatol. 2005;22(1):1–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Champion RH, Rook A, Wilkinson DS, Ebling FJG. Rook/Wilkinson/Ebling textbook of dermatology. 6th ed. Oxford Malden, MA: Blackwell Science; 1998.Google Scholar
  19. 19.
    Contact dermatitis: a practice parameter. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2006;97(3 Suppl 2):S1-38.Google Scholar
  20. 20.
    • Bonitsis NG, Tatsioni A, Bassioukas K, Ioannidis JP. Allergens responsible for allergic contact dermatitis among children: a systematic review and meta-analysis. Contact Dermatitis. May 2011;64(5):245-257. Meta-analysis to evaluate the proportion of positive reactions for allergens tested in children, offering guidance on relevant contact allergens in the pediatric population. PubMedCrossRefGoogle Scholar
  21. 21.
    Heine G, Schnuch A, Uter W, Worm M. Frequency of contact allergy in German children and adolescents patch tested between 1995 and 2002: results from the Information Network of Departments of Dermatology and the German Contact Dermatitis Research Group. Contact Dermatitis. 2004;51(3):111–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Rycroft RJG. Textbook of contact dermatitis. 3rd ed. Berlin New York: Springer; 2001.Google Scholar
  23. 23.
    Fernandez Vozmediano JM, Armario Hita JC. Allergic contact dermatitis in children. J Eur Acad Dermatol Venereol. 2005;19(1):42–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Larsson-Stymne B, Widstrom L. Ear piercing–a cause of nickel allergy in schoolgirls? Contact Dermatitis. 1985;13(5):289–93.PubMedCrossRefGoogle Scholar
  25. 25.
    Rystedt I, Fischer T. Relationship between nickel and cobalt sensitization in hard metal workers. Contact Dermatitis. 1983;9(3):195–200.PubMedCrossRefGoogle Scholar
  26. 26.
    Dotterud LK, Falk ES. Metal allergy in north Norwegian schoolchildren and its relationship with ear piercing and atopy. Contact Dermatitis. 1994;31(5):308–13.PubMedCrossRefGoogle Scholar
  27. 27.
    Christensen OB, Moller H. Nickel allergy and hand eczema. Contact Dermatitis. 1975;1(3):129–35.PubMedCrossRefGoogle Scholar
  28. 28.
    Veien NK, Hattel T, Laurberg G. Low nickel diet: an open, prospective trial. J Am Acad Dermatol. 1993;29(6):1002–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Antico A, Soana R. Chronic allergic-like dermatopathies in nickel-sensitive patients. Results of dietary restrictions and challenge with nickel salts. Allergy Asthma Proc. 1999;20(4):235–42.PubMedCrossRefGoogle Scholar
  30. 30.
    Sharma AD. Relationship between nickel allergy and diet. Indian J Dermatol Venereol Leprol. 2007;73(5):307–12.PubMedCrossRefGoogle Scholar
  31. 31.
    Belsito DV. Thimerosal: contact (non)allergen of the year. Am J Contact Dermat. 2002;13(1):1–2.PubMedCrossRefGoogle Scholar
  32. 32.
    van’t Veen AJ. Vaccines without thiomersal: why so necessary, why so long coming? Drugs. 2001;61(5):565–72.PubMedCrossRefGoogle Scholar
  33. 33.
    Roul S, Ducombs G, Taieb A. Usefulness of the European standard series for patch testing in children. A 3-year single-centre study of 337 patients. Contact Dermatitis. 1999;40(5):232–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Trattner A, David M. Patch testing with fine fragrances: comparison with fragrance mix, balsam of Peru and a fragrance series. Contact Dermatitis. 2004;49(6):287–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Larsen W, Nakayama H, Lindberg M, et al. Fragrance contact dermatitis: a worldwide multicenter investigation (Part I). Am J Contact Dermat. 1996;7(2):77–83.PubMedCrossRefGoogle Scholar
  36. 36.
    Zug KA, Warshaw EM, Fowler Jr JF, et al. Patch-test results of the North American Contact Dermatitis Group 2005-2006. Dermatitis. 2009;20(3):149–60.PubMedGoogle Scholar
  37. 37.
    Hjorth N. Eczematous allergy to balsams, allied perfumes and flavouring agents, with special reference to balsam of Peru. Acta Derm Venereol Suppl (Stockh). 1961;41 Suppl 46:1–216.Google Scholar
  38. 38.
    Bedello PG, Goitre M, Cane D. Contact dermatitis and flare from food flavouring agents. Contact Dermatitis. 1982;8(2):143–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Salam TN, Fowler Jr JF. Balsam-related systemic contact dermatitis. J Am Acad Dermatol. 2001;45(3):377–81.PubMedCrossRefGoogle Scholar
  40. 40.
    Veien NK, Hattel T, Justesen O, Norholm A. Reduction of intake of balsams in patients sensitive to balsam of Peru. Contact Dermatitis. 1985;12(5):270–3.PubMedCrossRefGoogle Scholar
  41. 41.
    Veien NK, Hattel T, Justesen O, Norholm N. Oral challenge with balsam of Peru. Contact Dermatitis. 1985;12(2):104–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Fisher AA, Rietschel RL, Fowler JF. Fisher’s contact dermatitis. 6th ed. Hamilton: BC Decker Inc.; 2008.Google Scholar
  43. 43.
    Bjarnason B, Flosadottir E. Patch testing with neomycin sulfate. Contact Dermatitis. 2000;43(5):295–302.PubMedCrossRefGoogle Scholar
  44. 44.
    De U, Pal DK. Seventy cases of non-tubercular psoas abscess at a rural referral centre in South Bengal. Tropical doctor. 2006;36(1):53–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Kwittken PL, Rosen S, Sweinberg SK. MMR vaccine and neomycin allergy. Am J Dis Child. 1993;147(2):128–9.PubMedGoogle Scholar
  46. 46.
    Paulsen E, Otkjaer A, Andersen KE. Sesquiterpene lactone dermatitis in the young: is atopy a risk factor? Contact Dermatitis. 2008;59(1):1–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Belloni Fortina A, Romano I, Peserico A. Contact sensitization to Compositae mix in children. J Am Acad Dermatol. 2005;53(5):877–80.PubMedCrossRefGoogle Scholar
  48. 48.
    Beattie PE, Green C, Lowe G, Lewis-Jones MS. Which children should we patch test? Clin Exp Dermatol. 2007;32(1):6–11.PubMedGoogle Scholar
  49. 49.
    Jacob SE, Herro EM, Sullivan K, Matiz C, Eichenfield L, Hamann C. Safety and efficacy evaluation of TRUE TEST panels 1.1, 2.1, and 3.1 in children and adolescents. Dermatitis. 2011;22(4):204–10.PubMedGoogle Scholar
  50. 50.
    Camacho-Halili M, Axelrod S, Michelis MA, et al. A multi-center, retrospective review of patch testing for contact dermatitis in allergy practices. Ann Allergy Asthma Immunol. 2011;107(6):487–92.PubMedCrossRefGoogle Scholar
  51. 51.
    Davis MD, Bhate K, Rohlinger AL, Farmer SA, Richardson DM, Weaver AL. Delayed patch test reading after 5 days: the Mayo Clinic experience. J Am Acad Dermatol. 2008;59(2):225–33.PubMedCrossRefGoogle Scholar
  52. 52.
    Corazza M, Baldo F, Ricci M, Sarno O, Virgili A. Efficacy of new barrier socks in the treatment of foot allergic contact dermatitis. Acta Derm Venereol. 2011;91(1):68–9.PubMedGoogle Scholar
  53. 53.
    •• Fonacier LSMB. Contact Dermatitis: Elsevier Saunders; 2010. In depth reference on ACD in children with extensive discussion on pathogenesis, relevant allergens, diagnosis, and treatment. Google Scholar
  54. 54.
    Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol. 2006;118(1):152–69.PubMedCrossRefGoogle Scholar
  55. 55.
    Luger T, Paul C. Potential new indications of topical calcineurin inhibitors. Dermatology. 2007;215 Suppl 1:45–54.PubMedCrossRefGoogle Scholar
  56. 56.
    Bekersky I, Fitzsimmons W, Tanase A, Maher RM, Hodosh E, Lawrence I. Nonclinical and early clinical development of tacrolimus ointment for the treatment of atopic dermatitis. J Am Acad Dermatol. 2001;44(1 Suppl):S17–27.PubMedCrossRefGoogle Scholar
  57. 57.
    Belsito D, Wilson DC, Warshaw E, et al. A prospective randomized clinical trial of 0.1 % tacrolimus ointment in a model of chronic allergic contact dermatitis. J Am Acad Dermatol. 2006;55(1):40–6.PubMedCrossRefGoogle Scholar
  58. 58.
    Katsarou A, Makris M, Papagiannaki K, Lagogianni E, Tagka A, Kalogeromitros D. Tacrolimus 0.1 % vs mometasone furoate topical treatment in allergic contact hand eczema: a prospective randomized clinical study. Eur J Dermatol. 2012;22(2):192–6.PubMedGoogle Scholar
  59. 59.
    Mrowietz U, Klein CE, Reich K, et al. Cyclosporine therapy in dermatology. J Dtsch Dermatol Ges. 2009;7(5):474–9.PubMedGoogle Scholar
  60. 60.
    Heller M, Shin HT, Orlow SJ, Schaffer JV. Mycophenolate mofetil for severe childhood atopic dermatitis: experience in 14 patients. Br J Dermatol. 2007;157(1):127–32.PubMedCrossRefGoogle Scholar
  61. 61.
    Simon D. Systemic therapy of atopic dermatitis in children and adults. Curr Probl Dermatol. 2011;41:156–64.PubMedCrossRefGoogle Scholar
  62. 62.
    Granlund H, Erkko P, Reitamo S. Long-term follow-up of eczema patients treated with cyclosporine. Acta Derm Venereol. 1998;78(1):40–3.PubMedCrossRefGoogle Scholar
  63. 63.
    Verma KK, Bansal A, Sethuraman G. Parthenium dermatitis treated with azathioprine weekly pulse doses. Indian J Dermatol Venereol Leprol. 2006;72(1):24–7.PubMedCrossRefGoogle Scholar
  64. 64.
    Granlund H, Erkko P, Eriksson E, Reitamo S. Comparison of cyclosporine and topical betamethasone-17,21-dipropionate in the treatment of severe chronic hand eczema. Acta Derm Venereol. 1996;76(5):371–6.PubMedGoogle Scholar
  65. 65.
    Hon KL, Ching GK, Leung TF, Chow CM, Lee KK, Ng PC. Efficacy and tolerability at 3 and 6 months following use of azathioprine for recalcitrant atopic dermatitis in children and young adults. J Dermatolog Treat. 2009;20(3):141–5.PubMedCrossRefGoogle Scholar
  66. 66.
    Brandao MH, Gontijo B, Girundi MA, de Castro MC. Ear piercing as a risk factor for contact allergy to nickel. J Pediatr (Rio J). 2010;86(2):149–54.CrossRefGoogle Scholar
  67. 67.
    Jensen CS, Lisby S, Baadsgaard O, Volund A, Menne T. Decrease in nickel sensitization in a Danish schoolgirl population with ears pierced after implementation of a nickel-exposure regulation. Br J Dermatol. 2002;146(4):636–42.PubMedCrossRefGoogle Scholar
  68. 68.
    Thyssen JP. Nickel and cobalt allergy before and after nickel regulation–evaluation of a public health intervention. Contact Dermatitis. 2011;65 Suppl 1:1–68.CrossRefGoogle Scholar
  69. 69.
    Corrente S, Moschese V, Chianca M, et al. Temporary henna tattoo is unsafe in atopic children. Acta Paediatrica. 2007;96(3):469–71.PubMedCrossRefGoogle Scholar
  70. 70.
    Jacob SE, Zapolanski T, Chayavichitsilp P, Connelly EA, Eichenfield LF. p-Phenylenediamine in black henna tattoos: a practice in need of policy in children. Arch Pediatr Adolesc Med. 2008;162(8):790–2.PubMedCrossRefGoogle Scholar
  71. 71.
    DeLeo VA. p-Phenylenediamine. Dermatitis. 2006;17(2):53–5.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Luz S. Fonacier
    • 1
  • Marcella R. Aquino
    • 1
  • Tania Mucci
    • 1
  1. 1.Section of Allergy and ImmunologyWinthrop University HospitalMineolaUSA

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