Allergic contact dermatitis (ACD) in children is increasing. Sensitization to contact
allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are
atopic dermatitis, skin barrier defects and intense or repetitive contact with
allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of
haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined
dermatitis on the lower legs. Clinical polymorphism of
contact dermatitis to clothing may cause difficulties in diagnosing textile
dermatitis. Toys are another potentially source of
hapten exposure in children, especially from toy-cosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact
allergens in children are metals, fragrances, preservatives,
neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant
eczema are encountered. Children should be patch-tested with a selection of
allergens having the highest proportion of positive, relevant patch test reactions. The
allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational
allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or
therapy-resistant
eczema in children.