Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor - Study Letter
2016:82:2;186-188
doi: 10.4103/0378-6323.168938
PMID: 26585851

Patch testing in children: An experience from Kashmir

Yasmeen Jabeen Bhat, Iffat Hassan, Saniya Akhter, Farhan Rasool, Syed Mubashir
 Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir, India

Correspondence Address:
Yasmeen Jabeen Bhat
Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College, University of Kashmir, Srinagar, Jammu and Kashmir
India
How to cite this article:
Bhat YJ, Hassan I, Akhter S, Rasool F, Mubashir S. Patch testing in children: An experience from Kashmir. Indian J Dermatol Venereol Leprol 2016;82:186-188
Copyright: (C)2016 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Allergic contact dermatitis in children is a significant problem worldwide and should be an important diagnostic consideration in children with chronic refractory dermatitis. Allergic contact dermatitis used to be considered a rare problem in children but the prevalence is currently estimated to be between 14.5% and 70%. [1] Patch testing in children differs significantly from that in adults, although it is accepted that the dilution of allergens used should be same in both groups. [2]

In our study, all children in the age group of 1-18 years suffering from any persistent, pruritic, eczematous dermatitis including resistant classical atopic dermatitis and atypical atopic dermatitis were included. The study was conducted for a period of 1 year, from August 2013 to July 2014 in the contact dermatitis clinic of the Department of Dermatology, SMHS Hospital, Government Medical College, Srinagar, after obtaining approval of the institute ethics committee. A detailed history was taken followed by a thorough cutaneous examination. Patch test was performed after excluding any contraindications to the procedure.

A twenty-allergen Indian standard battery approved by the Contact and Occupational Dermatoses Forum of India (CODFI) and marketed by Systopics India Pvt. Ltd., was used. Readings were carried out as per the International Contact Dermatitis Research Group guidelines on day 2, 30 minutes after removal of the patches with a second reading on day 4 and again on day 7, if required. [3]

A total of 60 patients in the age group of 1-18 years were studied [Table - 1] with a mean age of presentation of 9.52 ± 2.13 (mean ± standard deviation) years. The male: female ratio was 1:1.8 and 68.3% of the patients were from urban areas. The most common presentation was pruritic eczematous dermatitis. The most common symptoms were itching and exudation. The sites commonly involved were hands, feet, face, eyelids, neck, legs and arms [Table - 2].

Table 1: Age-distribution of patients patch tested
Table 2: Gender-based profile of patients

A positive patch test was seen in 20 (33%) patients, 14 (70%) girls and 6 (30%) boys. Among these, 15 patients had positive reactions which were determined to be of "definite" or "probable" current clinical relevance. The total number of positive reactions was 44 (average of 2.2 reactions per patient). Eight patients showed a positive reaction to a single allergen and 12 to multiple allergens. Positive patch test reactions increased with age; 26.7% in 1-6 years, 26.9% in 7-12 years and 47.4% in 13-18 years age group [Table - 1].

Positive patch test reactions were common with nickel sulfate, cobalt chloride, neomycin sulfate, fragrance mix, potassium dichromate, paraphenylenediamine, balsam of peru, parthenium and black rubber mix [Table - 3]. In our study, nickel sulfate was the most common allergen causing 11 (25%) positive reactions with a positive relevance in 63.6% of the patients. Detailed questioning revealed the common sources to be metals in jewelry, ear piercing, zippers and cell phones. Co-sensitization with metals seems to be a cause for cobalt allergy. Use of topical antibiotics in patients of atopic dermatitis caused reactions to neomycin sulfate.

Table 3: Patch test reactions and relevance to Indian standard series

Exposure to cosmetics and perfumes resulted in positive reactions to fragrance mix and peru balsam. Use of leather footwear and construction activity at/near homes seemed to trigger hypersensitivity to potassium dichromate. Dyes in hair color and henna were triggers for paraphenylenediamine hypersensitivity. Rubber footwear was the most common trigger for hypersensitivity to rubber. Current relevance was seen in 23 (52.3%) of 44 positive patch test reactions. There was no significant statistical association between age, sex and atopic status with the occurrence of positive patch test reactions.

A patch test positivity rate of 33% in our study is comparable to previous studies done on adult subjects in Kashmir which showed a prevalence of 38.8%; quite low, however, when compared to other Indian studies. The lower prevalence may be because of probable exposure to different allergens in our population, not included in the Indian standard series. [4],[5],[6]

Our study demonstrates that the commercially available patch test devices are safe in the pediatric population and patch testing can be performed in children older than 12 years in the same manner as in adults. However, in children younger than 6 years of age, patch test is usually reserved for cases with a high likelihood of contact hypersensitivity. After the culpable allergens are identified by patch testing, and if the patient can take steps to evade them, a significant improvement in the dermatitis is usually seen. [7]

This study demonstrates a need for additional multi-center, prospective studies incorporating a larger sample size. The low prevalence of contact hypersensitivity in children suffering from chronic dermatitis at our centre could be due to the exclusion of many unidentified, yet important allergens of Kashmir in the kit we used. The development of a comprehensive and standard kit, specific to children, including all the allergens of national importance is an important part of addressing the issue of contact dermatitis in children in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Mortz CG, Andersen KE. Allergic contact dermatitis in children and adolescents. Contact Dermatitis 1999;41:121-30.
[Google Scholar]
2.
McAlvany JP, Sherertz EF. Contact dermatitis in infants, children, and adolescents. Adv Dermatol 1994;9:205-23.
[Google Scholar]
3.
Wilkinson DS, Fregert S, Magnusson B, Bandmann HJ, Calnan CD, Cronin E, et al. Terminology of contact dermatitis. Acta Derm Venereol 1970;50:287-92.
[Google Scholar]
4.
Garg T, Yadav P, Meena S, Chander R. Allergic contact dermatitis in children: Culpable factors, diagnosis and management. Astrocyte 2014;1:33-40.
[Google Scholar]
5.
Hassan I, Rather PA, Jabeen Y, Wani ZA, Altaf H, Nisa N, et al. Preliminary experience of patch testing at Srinagar, Kashmir. Indian J Dermatol Venereol Leprol 2013;79:813-6.
[Google Scholar]
6.
Sharma VK, Asati DP. Pediatric contact dermatitis. Indian J Dermatol Venereol Leprol 2010;76:514-20.
[Google Scholar]
7.
Agner T, Flyvholm MA, Menné T. Formaldehyde allergy: A follow-up study. Am J Contact Dermat 1999;10:12-7.
[Google Scholar]

Fulltext Views
52

PDF downloads
40
Show Sections