Children With Hand Eczema and Suspected ACD Have High Rate of Positive Patch Tests

child boy hand eczema dermatitis
A little redhead boy is showing the sunburn he has on his hands. His hands are very red and dry.
The percentage of positive and relevant allergens in those younger than 18 years with hand eczema referred for patch testing was determined.

Children with hand eczema (HE) who are referred for allergic patch testing for suspicion of allergic contact dermatitis (ACD) have a high positivity rate similar to that of children without HE, according to study findings published in the British Journal of Dermatology.

The researchers conducted a retrospective analysis of data from the North American Contact Dermatitis Group (NACDG) from 2000 to 2016 to determine the percentage of positive and currently relevant allergens in children and adolescents with HE referred for patch testing.

The cohort included 1634 children or adolescents (36.7% boys; 80.6% White); most were aged 11 to 17 years (73.3%), and 4.8% had employment. Almost half of the participants (48.1%) had a history of atopic dermatitis, 33% had a history of asthma, and 32.2% had a history of hay fever.

Of the overall cohort, 157 participants (10.1%) and 237 participants (14.5%) had hands coded as the primary site of dermatitis or any of up to 3 sites of dermatitis, respectively. Final physician diagnoses included ACD (49.4%), atopic dermatitis (37.1%), and irritant contact dermatitis (16.9%).

Multivariable logistic regression models showed that employment was the only association with an increased odds of any HE or primary HE. Children with HE, compared with those without HE, had similar percentages of positive patch tests (56.1% vs 61.7%, respectively; chi-square, P = .11). The 5 most common currently relevant allergens were nickel, methylisothiazolinone, propylene glycol, decyl glucoside, and lanolin.

HE was associated with a higher odds of relevance in 6 of the top 20 relevant allergens—lanolin, quaternium-15, Compositae mix, thiuram mix, 2-mercaptobenzathiazole, and colophony—but a lower odds of relevance for nickel. The allergens with the highest mean significance-prevalence index number were methylisothiazolinone, carba mix, thiuram mix, nickel, and methylchloroisothiazolinone/methylisothiazolinone.

The study found that “children with HE referred for patch testing because of a suspicion of ACD had a high proportion of positive patch test reactions, although not statistically different from children without HE,” wrote the investigators.

HE was associated with several differences in children and adults. “Compared to previous data for adult patients from our group (24.2%), children were numerically less likely to have HE (10.1%),” noted the study authors. This population also had lower percentages of ACD and irritant contact dermatitis than adults and higher percentages of atopic dermatitis alone and in combination with ACD.

Study limitations include a lack of data regarding HE, such as age of onset, duration, longitudinal course, and treatment history, and the NACDG database does not distinguish between specific HE distribution, severity, or phenotypes. Also, participants were mainly older children and adolescents, precluding any conclusions about younger children.

“In children referred for patch testing, HE was most commonly due to ACD and/or atopic dermatitis,” the researchers concluded. “Employment was strongly associated with higher odds of HE in children. Pediatric HE was associated with multiple allergens that are commonly used in personal care products and topical medications, though a less diverse profile of allergens compared to adults with HE.”

Disclosures: Some of the authors reported affiliations with pharmaceutical companies. Please see the original reference for a full list of disclosures.


Silverberg JI, Warshaw EM, Maibach HI, et al. Hand eczema in children referred for patch testing: North American Contact Dermatitis Group data, 2000–2016. Br J Dermatol. doi: 10.1111/bjd.19818