Contact Dermatitis: Pediatric and Session Insights

Jeff Yu, MD, is a board-certified dermatologist located at Massachusetts General Hospital in Boston, MA. He is also a specialist in allergic contact dermatitis, and occupational dermatitis in adults and children. His other clinical interests include eczema, genodermatoses, and pediatric dermatology across the whole spectrum. He is an active member in American Contact Dermatitis Society, Society of Pediatric Dermatology, Pediatric Dermatology Research Alliance, and the American Academy of Dermatology. In this video, Dr Yu gives insights into pediatric contact dermatitis and talks about his session from AAD Summer Meeting.

Transcript:

Dr Yu:  For pediatric patients, there are several challenges. The first challenge is whether or not we can get the child to go through with the processing process. It requires us to stick these annoying pieces of tape on their back and it bounds them down because we don't want them to dislodge.

Kids are obviously very active. They run around. They jump around. It's hard to tell a 3-year-old that you have to stay calm for the next 48 hours. They almost will never do that, however, so we apply a lot of tape. We really try to get the parents or the guardian to understand the importance of them just staying still. I think that's the first challenge.

The second challenge is space. We know from the patch testing literature, the more you patch test, the more likely you are to find the culprit allergen. When we're just doing, say, 30 patches, we're probably going to miss about a third or more of the potential positive reactions.

When we get up to 80, 90 patches, then we're really detecting somewhere in the upper 80s, lower 90s percentages of positive allergens. A 1 or 2 or even 3-year-old kid, we can't put that many allergens on them because we just don't have that much space.

We end up being a lot more picky in terms of what allergens we should put on and where we put them on. We'll use the back. Sometimes, we'll use the legs. We can't just put as broad a screening series as we would on an average size adult.

Finally, the third challenge is, how do we get the kids to comply with a lot of these things? Luckily, the kid is not really responsible for a lot of their own personal care product choices. It's really the parents.

A lot of times, by the time the kid makes it into our clinic, the parents are willing to do almost everything in terms of avoidance to get their kid better because the last thing they want to do is continue topical steroids, continue oral steroids, or do any sort of a systemic medication that could potentially have downstream effects on their child.

They're much more willing then to say, "We're going to change the Johnson & Johnson shampoo to something else. We're going to change the detergent to something else." They're much more willing to do that than to say, "Here's another pill that you're going to take," because I'm sure that by the time they've made it to me, they've been on a lot of other treatments already.

Contact dermatitis is a rapidly changing field. It's a very dynamic research community that's a part of the American Contact Dermatitis Society. There's a lot of research that gets done monthly on different contact allergens.

We're discovering allergens monthly to yearly. One of the most important ones that came out recently has to do with these adhesives and these wearable glucose monitors, which is becoming more and more popular, especially amongst the pediatric population, but also in the adult population.

Things like that, that a lot of endocrinologists and general dermatologists that just don't recognize, I think, by having a venue of easily readable and digestible material for the general public, as well as clinicians, is really important. Having some way to communicate would be really helpful, such as in the allergen sections for the dermatologists.

We're also doing a contact dermatitis session at the summer AAD. We're really excited that it's going to be the first live session since COVID. This symposium on contact dermatitis is taking place on Sunday, August 8th, between 9:00 AM and 12:00 PM in Ballroom C. We look forward to having a great attendance there.

We're going to have a great panel of speakers. The speakers are going to touch on several things, including updates on contact allergens, including contact allergens of the year and any new findings from the American Contact Dermatitis Society.

We're also going to feature speakers that are going to talk about contact dermatitis that's relevant to the summer including things like plants such as poison ivy, poison sumac, as well as sunscreens.

A big focus of the contact and patch testing community right now has been on patch testing in patients with skin of color. The majority of our patients or the majority of the research we previously have published have focused mostly on the Caucasian population.

We do know that, as the population of the United States changes, we are certainly looking to do more research and trying to establish more data on the patients of skin of color who are patch testing on. Eg, we have a speaker who is going to talk about research that's recently been done on Asian, Hispanic, as well as Black patients in patch testing and sharing some of that data, in adults as well as in children.

Finally, we're definitely going to talk about atopic dermatitis and contact dermatitis and how that plays a role with atopic dermatitis. I think we're going to have a lot of great sessions. We really look forward to having people attend.