Contact dermatitis in pediatric age

Right from birth, children's skin is exposed to a wide range of environmental attacks of both chemical and physical type, and can therefore develop various clinico-pathogenetic expressions of contact dermatitis. The most common forms of contact irritation are contact dermatitis in the diaper region and keilitis and perioral contact dermatitis (due to foods and saliva). In the past, allergic contact dermatitis (ACD) was considered rare in children on 2 grounds: that there might be reduced exposure to allergens in childhood and that children's immune system could be less susceptible to contact allergens. In the last 20 years, however, many literature studies have shown a high incidence of contact allergy in childhood, up to 20% of all forms of dermatitis, according to some authors. The studies in selected patients found that although ACD is rare in the first months of life, the percentage of positive reactions to the patch test ranges from 14.5% to 70.7% of cases. The most common allergens are nickel, cobalt, chromium, fragrances and rubber additives. Most studies show a predominance of the complaint in the female sex due to more frequent contact allergy to nickel. The few available data on unselected groups of children, mainly performed in schoolchildren between 5 and 14 years old, report an incidence of positive reactions from 13.3% to 23.3%. Contact allergy is not uncommon in children with atopic dermatitis, particularly in subjects affected by moderate forms of the complaint. Patch tests can and must be performed in childhood in all cases of suspected ACD, using the same allergens and the same concentrations as in adults.