D1.60 - Clinical Characteristics of Children with Patch Test–Positive Allergic Contact Dermatitis: Effects of Treatment on Quality of Life

Allergic contact dermatitis (ACD) is a delayed-type (type IV) hypersensitivity reaction that is increasingly recognized in children. Because it can clinically mimic other dermatoses—particularly atopic dermatitis (AD)—it should be considered in the differential diagnosis of pediatric patients. Patch testing remains the gold standard for the diagnosis of ACD.

This cross-sectional study included 222 pediatric patients diagnosed with ACD at the Pediatric Immunology and Allergy Clinic of Ankara Etlik City Hospital between July 1, 2023, and July 1, 2025. Demographic characteristics, clinical features, and laboratory findings were evaluated. In patients with positive patch test results, treatment responses and quality of life were assessed using the Children’s Dermatology Life Quality Index (CDLQI).

Of the patients, 58.6% were female, and the mean age was 151.4 months (range: 38–246 months). The most commonly affected sites were multiple body areas (50.9%) and the hands/feet (20.7%). Patch testing was performed using the Thin-Layer Rapid-Use Epicutaneous (TRUE) Test in 185 patients (83.3%) and the European Standard Series (ESS) in 37 patients (16.7%).

Positive patch test results were observed in 91 patients (41%); 44% had sensitivity to a single allergen, while 25% were sensitized to two or more allergens. Nickel was the most frequently identified allergen (n=30), followed by gold sodium thiosulfate (n=20) and methylchloroisothiazolinone (MCI) (n=18).

Concomitant allergic diseases were present in 49.6% of patients, with atopic dermatitis (26.6%) and allergic rhinitis (17.5%) being the most common.

Consistent with previous literature, nickel was the most common allergen identified in pediatric ACD. Gold salt positivity was significantly higher in girls (p=0.04), possibly related to gender-specific jewelry and accessory use. MCI positivity was significantly associated with hand and foot involvement (p=0.002), likely reflecting frequent exposure to household products such as detergents, soaps, and wet wipes.

The lower complete treatment response rate among MCI-positive patients (p=0.024) suggests that avoidance of this allergen is particularly challenging in daily life. The presence of AD was associated with multiple allergen sensitization and varied lesion localization (p=0.001), supporting the hypothesis that epidermal barrier dysfunction in AD facilitates allergen penetration and predisposes to the development of ACD.

An overall complete response rate of 80.2% was achieved. Higher response rates in patients receiving combination therapy indicate the beneficial role of adjunctive treatments, whereas lower response rates in patients receiving more than three treatment modalities likely reflect greater disease severity.

A significant improvement in CDLQI scores after treatment (p=0.001) demonstrates that individualized management can substantially improve quality of life in children with ACD.