ACD in children

Allergic contact dermatitis in children

Patch tests in healthy, asymptomatic children show 13–25% have allergen sensitization; this rises to 25–96% in children with suspected ACD.
Plant- and nickel contact are two of the most common presentations; ACD can also be caused by clothing labels and slime toys.
Children with atopic dermatitis have a barrier defect in combination with immune dysregulation. This can increase permeation of allergens, irritants and microbes. It is also possible for children to have ACD on top of atopic dermatitis.

Children and adults have different clinical morphology and distribution of ACD. In children, 33% show a scattered, generalized pattern; in adults, ACD most commonly presents on the hands (27%).
Adults are generally in control of the products they are exposed to and use on their skin, and children less so.
The allergen source typically changes over life – in childhood, toys and sporting equipment are more commonly drivers of ACD, but there is still a significant overlap between the most common allergens in both children and adults, with nickel, fragrance and preservatives.
Regional clues may differ in children and adults. Eyelid dermatitis in a child may be due to shampoos or cleansers, toys, googles or helmets. Rashes on the buttocks may be due to the material or cleaners used on toilet seats or potty-training equipment. ACD on the lips may be due to musical instruments, lip balms, pacifiers or toys.

There has been an increase reported in ACD to glucose sensors,^1,2 with 83% patch-test positive to isobornly acrylate.
Finally, acetophone azine has been announced as the ACDS ‘Allergen of the Year’ for 2021. This allergen is found in foam padding commonly used in shin pads, shoes, and flipflops, and can penetrate fabrics.³