A recent study published in the Journal of the American Academy of Dermatology sought to evaluate the prevalence of allergic contact dermatitis (ACD) in children with atopic dermatitis (AD).
According to Johnson et al., both ACD and AD have similar clinical presentations. As such, in cases where ACD may be present, many children are not being referred for patch testing and it therefore goes undiagnosed.
The study, a retrospective case-control study that used data from the Pediatric Allergic Contact Dermatitis Registry from 2018 to 2022, included 912 children. A total of 615 children in the study had AD and 297 did not. Researchers found that those children with AD were more likely to:
- Have a longer history of dermatitis
- Have seen more providers
- Have greater than one positive patch test (PPT) result
- Have a greater number of PPT results overall
- Have a more generalized distribution of dermatitis
The authors note that the estimated prevalence of ACD in children within the general population is 16.5%. Despite this, less than 10% of patch testing is performed. They note that this may be due partially to the difficulty in distinguishing between AD and ACD clinically, seeing as both conditions present with red, itchy, eczema-like patches and plaques on the skin. As ACD cases continue to be mistaken for AD, patch testing tends not to be performed, resulting in ongoing underdiagnoses.
A number of limitations were noted throughout this study, namely, the presence of technical variables that may have influenced patch-testing outcomes as these were performed at different centers, possible misclassification bias, possible selection bias as most children included were white girls meaning results may not be generalizable to other populations, and not having access to the patient’s medical records.
Despite these limitations, the authors noted that their findings support “the importance of referring children with AD for patch testing to consider ACD as an important comorbidity.”
“The results of this study underscore the need for children with AD to be referred to a specialist for evaluation of ACD. Uncovering potentially relevant contact allergens can lead to improvement in quality of life, can decrease use of topical steroids and systemic immunosuppressants, and can significantly lessen overall disease severity.”
Sources:
- Johnson H, Aquino M, Snyder A, et al. Prevalence of allergic contact dermatitis in children with and without atopic dermatitis: a multicenter retrospective case-control study. J Am Acad Dermatol. doi:10.1016/j.jaad.2023.06.048
- https://www.sciencedirect.com/science/article/abs/pii/S0190962223012707
- https://www.ajmc.com/view/children-with-ad-more-likely-to-react-to-at-least-1-allergen-during-patch-testing-study-saysen-during-patch-testing-study-says
