North American study of hand eczema in children

Linked Article:   Silverberg et al . Br J Dermatol 2021; 185 :185–194. Hand eczema (HE) is often triggered by something in contact with the skin, either an irritant (such as detergent) or a substance to which the person is allergic. Allergic contact dermatitis (ACD) is diagnosed by patch testing: substances that commonly cause allergy (allergens), placed in small chambers mounted on tape, are stuck on the upper back; after 48 hours the tape is removed and a patch of eczema at the site of a particular allergen reveals the culprit. Most research into ACD has been on adults and the cause is usually related to their work. Children are exposed to different substances so they might need to be patch tested with different allergens. This study examined data from 1634 children under 18 years patch tested between 2000 and 2016 in dermatology clinics across the USA and Canada. Of these, 237 had HE. The final diagnosis was usually ACD and/or atopic dermatitis (AD); AD was no commoner in those with HE than in those without. Using the North American Contact Dermatitis allergen set, the top 10 positive reactions were nickel, cobalt, thimerosal, formaldehyde, methylisothiazolinone, propylene glycol, neomycin, fragrance mix, lanolin and decyl glucoside. Compared with adults there were fewer allergens, but more that are commonly used in personal care products and topical medications (i.e. medications that are applied directly to the skin). As in adults, employment was strongly associated with risk of HE: of 77 children with HE in employment (in beauty, healthcare, hospitality, car‐wash, retail or farming) seven had ACD and 28 had irritant contact dermatitis caused by occupational exposure.