Can my Child have both Atopic and Contact Dermatitis?
Contact dermatitis is more common in adults, but it is possible that a patient with atopic dermatitis also have contact dermatitis. The logic is that eczema skin barrier is defective, thus more vulnerable to hypersensitive reaction to chemicals. The chemicals which I’ve found from recent years’ studies which affect eczema patients (not necessarily children) more than non-eczema patients are
Surfactants cocamidopropyl betaine (CAPB), from AAD study. Also quaternium-15, imidazolidinyl urea, DMDM hydantoin, and 2-bromo-2-nitropropane-1,3-diol (from another AAD study)
How does dermatologist treat Contact Dermatitis?
The treatment is similar to atopic dermatitis, so in a sense it may not be as critical if the two cannot be differentiated. The difference is that without avoiding the substance that is causing the hypersensitive reaction, it is then not possible to keep it from causing the rash. Moisturizing, medicated cream, compresses to relieve itch and soothe skin, and antihistamines for reduced scratching at night may be prescribed.
In finding out which are the irritants involved in contact dermatitis, a patch test can be carried out (read more here). Patch test involves placing the suspected irritants/chemicals (note: there is a ‘science’ as to how much to put and how to prepare the liquid, don’t try to do this yourself) on paper tape on your child’s back or arm. The tape will be left on for about 48 hours and observation be noted by the dermatologist.
Is my child more likely to have contact dermatitis as an adult?
I haven’t come across such study, but it makes sense to figure out the irritants early and to avoid them. Also to treat the eczema promptly and take measure to protect the child’s skin barrier so that it is more robust against irritants when the child is older. (At the same time, I’m thinking she has got to fend for herself when old, I’m not going to say ‘Stop Scratching’ till I’m 60 year old!)
What are the preventive measures for contact dermatitis?
Avoidance is key, especially once you or your child has undergone patch testing and knows which substance triggers the hypersensitive reaction. There are common chemicals that are present in contact dermatitis in children (US), and these are nickel, neomycin, cobalt, fragrance, Myroxylon pereirae, gold, formaldehyde, lanolin/wool alcohols, thimerosal, and potassium dichromate. Also for those without any allergy, but has eczema (known as ‘intrinsic eczema’), this study suggest the possibility of nickel and cobalt allergy.
This study provides a percentage of common allergens for eczema children, nickel (16.3%), cobalt (6.9%), Kathon CG (5.4%), potassium dichromate (5.1%), fragrance mix (4.3%), and neomycin (4.3%).
The above chemical names may be too difficult to remember, so below is a compilation of where they may be commonly present in:
Soaps and detergents
Saliva
Urine (common cause of diaper rash)
Baby lotions, avoid perfume/fragrance products, preservatives
Latex, e.g. rubber products
We’ve covered the basics and the conclusion may be to be aware of contact dermatitis and promptly remove the suspected irritants. When the child is older, say 5 year old, bring him/her to a patch test.
Read last week: Contact Dermatitis, does your Eczema Child have it?