Approximately one-third of children with Eczema may have one or more hidden contact allergies, possibly contributing to or maintaining the skin symptoms.
Metals were the most common allergens among patch tested children with Eczema, nickel being the most common. Reactions to cobalt chloride and potassium dichromate were also frequent among the children with Eczema. Fragrance, too, is a common sensitizer in children.
Lanolin, and Amerchol L101, a lanolin derivative that is used as an emollient and emulsifier in ointments and in cosmetic products such as soaps, shampoos, hair conditioners, aftershaves, baby and bath oils, hand sanitizers, lipsticks and creams.Six of the reviewed studies patch tested with Amerchol L101 and all reported relatively high sensitization rates.
Although corticosteroids are not potent allergens, contact sensitization and ACD from topical corticosteroids is not infrequent. The possibility of a complicating contact allergy to topical treatments should not be ignored in the evaluation of a child with recalcitrant eczema.
Patch testing for contact allergens may be relevant as a screening tool in the management of children with AD and should always be considered in cases of recalcitrant AD or whenever ACD is suggested by the child’s history.