University of Massachusetts School of Medicine, Worcester, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
J Am Acad Dermatol. 2021 Feb;84(2):235-244. doi: 10.1016/j.jaad.2020.11.002. Epub 2020 Nov 17.
Allergic contact dermatitis (ACD), a delayed hypersensitivity skin reaction to environmental allergens, has a prevalence that is similar in children and adults. However, diagnostic testing for ACD in pediatric populations accounts for less than one tenth of all patch tests. The relative infrequency of pediatric patch testing may be attributed to the difficulty in testing in this population, which includes a smaller surface area for patch test placement and maintaining cooperation during patch testing, especially in younger children. Diagnosis can be difficult in children because the appearance of ACD can mimic other common pediatric skin conditions, particularly atopic dermatitis and irritant contact dermatitis. Comprehensive history taking, guided by patient presentation, age group, and location of dermatitis, helps build clinical suspicion. Such clinical suspicion is one of the major reasons behind patch testing, with additional indications being recalcitrant dermatitis and dermatitis with atypical distribution. US pediatric data have shown the top allergens to be metals, fragrances, topical antibiotics, preservatives, and emollients. These trends are important to recognize to guide management and accurate diagnosis, because ACD tends to persist if the allergen is not identified and can affect patients' quality of life.
变应性接触性皮炎（ACD）是一种对环境变应原的迟发型超敏反应性皮肤疾病，其在儿童和成人中的患病率相似。然而，儿科人群中 ACD 的诊断性检测在所有斑贴试验中所占比例不到十分之一。儿科斑贴试验的相对频率较低可能归因于该人群的检测难度，包括贴斑试验部位的表面积较小，以及在贴斑试验期间保持合作，尤其是在年龄较小的儿童中。儿童的诊断可能较为困难，因为 ACD 的表现可能类似于其他常见的儿科皮肤疾病，特别是特应性皮炎和刺激性接触性皮炎。全面的病史采集，根据患者的表现、年龄组和皮炎的位置进行指导，有助于建立临床怀疑。这种临床怀疑是进行斑贴试验的主要原因之一，其他指征包括难治性皮炎和非典型分布的皮炎。美国儿科数据显示，最常见的过敏原是金属、香料、局部抗生素、防腐剂和保湿剂。这些趋势很重要，因为如果未识别出过敏原，ACD 可能会持续存在并影响患者的生活质量，因此需要识别这些趋势以指导管理和准确诊断。
