Dr. JiaDe Yu discusses pre-emptive avoidance strategies for common sources of pediatric allergic contact dermatitis.
JiaDe Yu, MD, FAAD, is Assistant Professor of Adult and Pediatric Dermatology, Director of Contact and Occupational Dermatitis Clinic, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
“About 20% of kids have allergic contact dermatitis of some sort,”1 said JiaDe Yu, MD, FAAD, who presented “Allergen Alternatives to Pediatric Allergic Contact Dermatitis: Solutions, Not Mysteries” at the 34th Annual Society for Pediatric Dermatology Pre-AAD meeting in Boston, Massachusetts.
Yet children are rarely referred for patch testing, which looks for sources of contact allergy, including things like preservatives, metals, and fragrances, according to Dr. Yu.
“A lot of pediatric dermatologists see patients who might have contact dermatitis, but most places in the United States and most children’s hospitals do not have somebody who does patch testing. Therefore, pre-emptive avoidance strategies, such as knowing safe alternatives, are really important.”
According to Dr. Yu, there are three common sources of contact dermatitis to be aware of: methylisothiazolinone, isobornyl acrylate, and acetophenone azine.
Methylisothiazolinone
One of today’s most common allergens is a preservative called methylisothiazolinone found in personal care products. Manufacturers started using the preservative in the mid-2000s, according to Dr. Yu.
“The industry thought methylisothiazolinone was a great idea, started putting it in their products, and we started to see skyrocketing cases of allergy to methylisothiazolinone. Especially for kids, we’re talking about [this preservative being in] soaps, shampoos, ingredients in things like Slime and also laundry detergents, because ingredients such as laundry detergents are sometimes used to make toys like Slime. Even school glues can also have methylisothiazolinone in them.”
To address the allergen, dermatologists might recommend soaps, shampoos, glues, and other personal care products that don’t contain methylisothiazolinone, said Dr. Yu.
“In terms of soaps, companies such as CeraVe and Cetaphil do not use methylisothiazolinone in most of their products and would be safe options for kids.”
Isobornyl Acrylate
Many of today’s wireless glucose monitors for kids with diabetes are causing allergic contact dermatitis, according to Dr. Yu.
“These wireless glucose sensors are convenient and very popular because you don’t have to wear something on your hip. There are no cords that run into your body and there are not finger pricks that you need to do routinely throughout the day. However, a lot of these kids—up to a third—have reported some sort of contact dermatitis, whether that is an itchy rash due to the process of putting it on and taking it off or because of a chemical that has been identified in these glucose sensors called isobornyl acrylate.”
Isobornyl acrylate is in the adhesives of many wireless glucose sensors on the market, he said.
“There are different brands like Freestyle Libre 2 (Abbott) that does not have this chemical, but Freestyle Libre 1 does. So, switching over to a glucose monitor that doesn’t have that chemical can often help prevent that rash.”
For kids that don’t have the option of switching, Dr. Yu said he recommends using a very thin barrier between the adhesive and skin, such as Tegaderm (3M), DuoDERM (Convatec), or any of the very thin barrier sheets that patients can put underneath the glucose sensor.
Acetophenone Azine
“Sports equipment is a popular source of potential rashes underneath the equipment. I talked about a girl who plays hockey 11 out of 12 months, and every time she wears her pads, she gets a rash especially in those areas where the pads come in direct contact with the skin. A recently identified allergen called acetophenone azine was discussed.”
Acetophenone azine is common in different types of sports foams, especially in ethylene-vinyl acetate (EVA) foam, said Dr. Yu.
“EVA was not previously identified, so a lot of cases of contact dermatitis were thought to be due to irritation from sweat. Now we know it is due to this chemical. By avoiding these foams and looking for alternatives from sports equipment retailers, we can often avoid these rashes.”
A Need for Patch Testing
In a retrospective study of 43,722 North American Contact Dermatitis Group patients patch tested from 2001 to 2018, only 1,800 were pediatric patients, according to Dr. Yu.2
“I think part of the reason for that is either providers do not recognize that allergic contact dermatitis happens in children, they don’t have anywhere to refer these kids, or they are not often thinking about allergic contact dermatitis. One of the reasons for that is eczema or atopic dermatitis is so common in children. So, when you see a kid with a rash, you often think it is underlying eczema when, in reality, about 40% of these kids may have some kind of superimposed contact dermatitis.”3
“If we’re not referring these kids to a specialist to evaluate them for allergic contact dermatitis, we may be mis-identifying a potential trigger for their rashes and may be missing an opportunity to get them off of their topical steroids or systemic immunosuppressive medications …. So, if you are seeing kids with unusual rashes—maybe things that don’t fit the clinical paradigm of atopic dermatitis—consider referring them to somebody for patch testing because you may find a potentially relevant allergen in these kids.”
Disclosures: Dr. Yu reports no relevant disclosures.
References:
- Boonchai W, Chaiyabutr C, Charoenpipatsin N, et al. Pediatric contact allergy: A comparative study with adults. Contact Dermatitis. 2021;84(1):34-40. doi:10.1111/cod.13672
- Silverberg JI, Hou A, Warshaw EM, et al. Age-related differences in patch testing results among children: Analysis of North American Contact Dermatitis Group Data, 2001-2018. J Am Acad Dermatol. 2022;86(4):818-826. doi:10.1016/j.jaad.2021.07.030.
- Jacob SE, McGowan M, Silverberg NB, et al. Pediatric Contact Dermatitis Registry Data on Contact Allergy in Children With Atopic Dermatitis. JAMA Dermatol. 2017;153(8):765-770. doi:10.1001/jamadermatol.2016.6136.