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Patch testing in early childhood should be approved to spare steroid use
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Despite recent biologics and systemic medication approvals for atopic dermatitis and psoriasis, the FDA has not yet approved patch testing for skin allergy in early childhood. FDA approval and nationwide mandated patch testing for an allergy to a chemical antigen could have the potential to yield healthier lives for children as well as reduced costs to families and insurance providers.
Read a comment from an expert contacted by Infectious Diseases in Children on the recent history of patch testing, the benefits it offers to the pediatrician caring for a child with skin disease and how determining a contact allergen early eradicates the need for steroid implementation.
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Sharon E. Jacob, MD, is an associate clinical professor of pediatrics and medicine in the department of dermatology at the University of California, San Diego School of Medicine.
Patch testing is a diagnostic tool whereby chemical contact antigens (haptens) are placed on the skin and allowed to absorb for 24 to 48 hours after which the patient returns to have the patches removed and evaluated. The patient then returns 48 to 96 hours after the removal to determine if a reaction has developed; if so, it means that the immune system recognizes the chemical.
Atopic children can have allergic contact dermatitis. If a chemical contact allergen is perpetuating their dermatitis and the culprit is detected and avoided, the child gets better, and it is dramatic positive change. [My colleagues and I have] had children on systemic steroids with repeated skin infections be evaluated by patch testing, determine a relevant chemical contact antigen - avoid it - and go into remission and live happy healthy lives again.
Over the last decade, allergic contact dermatitis in children has become more widely recognized. It was considered rare, but we now know that not to be true. Pediatricians appropriately refer to pediatric dermatologists; not all pediatric dermatologists and general dermatologists do patch testing. Patch testing was developed by the German dermatologist Josef Jadassohn over a century ago - ideally all dermatologists would be able to provide these services.
Patch testing in children is not FDA approved; that being said, it is still a necessity for consideration in children with recalcitrant dermatitis. Patch testing can be a steroid-sparing intervention.
Disclosure: Jacob reports she is founder and CEO of the Dermatitis Academy, president-elect of the American Contact Dermatitis Society and serves as a consultant for Johnson & Johnson.