Among the cases of atopic eczema (AE) that are diagnosed in children, a portion of these cases may actually be allergic contact dermatitis (ACD), according to researchers from Jagiellonian University Medical College in Poland.
In an effort to determine how the clinical similarities between these two conditions may lead to misdiagnosis, the researchers recruited children who answered affirmatively to questions from the eczema module of the International Study of Asthma and Allergies in Childhood (ISAAC). In all, 143 children were included. Each participant was examined by a pediatrician and an allergist and underwent patch testing.
More than half of the children involved in the study (55.4%) and 30% of adolescents were diagnosed with AE, while 38.6% of children and 51.7% of adolescents were diagnosed with ACD. Also according to the researchers, who published the study in the Journal of the European Academy of Dermatology and Venereology, 19.6% of children and 52% of adolescents with affirmative answers to the questions about flexural eczema were diagnosed with ACD, although these children did not meet the features sufficient for the diagnosis of AE according to Hanifin and Rajka. The researchers reported that, based on indices from the entire population that was tested (9,320 pupils), “a rough estimate of the general ACD prevalence was 5.8% for adolescents and 8.5% for children, which is close to the figure of 7.2% observed previously in Danish schoolchildren.”
The conclusion to be drawn here, according to the researchers, is that actual cases of ACD may initially be misdiagnosed as AE. Data from the study shows that cases of eczema based on the ISSAC module are “an epidemiological entity that embraces comparable portions of cases of atopic eczema and allergic contact dermatitis, and possibly also other less frequent pruritic dermatoses.”
The researchers also believe that chronic, recurrent dermatitis in children “requires differential diagnosis aimed at allergic contact dermatitis and inflammatory dermatoses other than atopic eczema, even when predominantly localized in flexural areas.”
