Ingredients in eczema topicals pose contact dermatitis risk

Ingredients in the very personal care products and other topicals used to relieve skin symptoms and itch in children with atopic dermatitis put these children at greater risk for contact dermatitis, according to a study published August 17 in JAMA Dermatology.

The understanding of the interplay between atopic and contact dermatitis is continuing to evolve, according to the original investigation’s lead author dermatologist Sharon Jacob, M.D.

“Atopic dermatitis patients have an amplified risk of sensitization because they are primarily treated with topical regimens that potentially expose them to product-based chemicals,” Dr. Jacob says “And they have an impaired epidermal barrier that potentially enhances absorption through the skin.”

U.S. researchers in the specialties of pediatric dermatology and allergy and immunology studied a retrospective case review of 1142 children. The patients had been patch tested for sensitizations to various allergens in 2015 by healthcare providers around the U.S. The providers noted whether or not patients had atopic dermatitis. Among those studied, 552, or 189 boys and 363 girls, had atopic dermatitis.

They found that children with atopic dermatitis who came in for patch testing were on average younger and had nearly twice as long a history of dermatitis as children without atopic dermatitis.

Asian patch tested patients were 1.92 times more likely to have concurrent atopic dermatitis, and African Americans were 4 times more likely to have concurrent atopic dermatitis than those without the skin disease.

Interestingly, the reaction profiles of children with atopic dermatitis differed from those without. Children with eczema were more likely than those without to react to allergens found in their skincare preparations: cocamidopropyl betaine, wool alcohol, lanolin, tixocortol pivalate, and parthenolide. Children in the eczema group were less likely than children without atopic dermatitis to react to methylisothiazolinone, cobalt and potassium dichromate.

“[It’s] important to note that inflamed skin enhances sensitization of less potent allergens, such as cocamidopropyl betaine, which is a well-known cause allergic sensitization in atopic dermatitis,” says Dr. Jacob, President of the American Contact Dermatitis Society and founder and CEO of the Dermatitis Academy, a free “webucation” resource. “Evaluation for allergic contact dermatitis through appropriate patch testing should be considered in children with recalcitrant dermatitis. Manufacturers can utilize this data set to select less sensitizing chemicals for their products. Providers can use data sets, such as these, to prescribe pre-emptive avoidance strategies (P.E.A.S.) to guide their patients.”

Dr. Jacob coauthored the Pre-emptive avoidance strategy 2016: update on pediatric contact dermatitis allergens, published online in late 2016, in the Expert Review of Clinical Immunology. The authors reviewed pediatric contact dermatitis studies looking at rates of positive patch tests in pediatric patients with and without atopic dermatitis who had been evaluated by patch testing for suspected allergic contact dermatitis. They found the burden of pediatric contact dermatitis to be significant, and indicated that there is the need to avoid highly prevalent allergens in “child-intended personal products.” The article offers a table on the current top sensitizing chemicals in personal care products.

Did you know?

• Cocamidopropyl is a surfactant found in moisturizers, cleansers, shampoos and more. 
• Wool alcohol is used as an emollient. 
• Lanolin is used to make soaps and lotions. 
• Tixocortol pivalate is found in over-the-counter antiinflammatory and corticosteroid creams and ointments. 
• Parthenolide can be found in over-the-counter antiinflammatory topicals.

Disclosures:

Dr. Jacob is the Founder/CEO of the dermatitis academy www.dermatitisacademy.com a free webucation resource. There was a pilot project grant from the Society of Pediatric Dermatology for the internet-technology database component of this study. Dr. Jacob received an American Contact Dermatitis Society Mid-Career Development Award towards training in Information and Communication Technology in association with this study.

References:

Sharon E. Jacob, MD; Maria McGowan, MD; Nanette B. Silverberg, MD; et al, “Pediatric Contact Dermatitis Registry Data on Contact Allergy in Children With Atopic Dermatitis,” JAMA Dermatology. August 2017. DOI: 10.1001/jamadermatol.2016.6136

Nikoleta Brankov, MD, and Sharon E. Jacob, MD, Pre-Emptive Avoidance Strategy 2016: Update on Pediatric Contact Dermatitis Allergens, Expert Review of Clinical Immunology, December 2, 2016. DOI: 10.1080/1744666X.2017.1262766.