Dawn Eichenfield, MD: Identifying Allergies in Pediatric Dermatology

The rate of allergies and allergic disease has increased significantly since the turn of the century; as a result, there is increased emphasis on screening and diagnostics among relevant clinicians, and an evolved interplay between specialists in impacted field—allergy and dermatology being among the most affected.

But some cases may go altogether missed at its earliest stages, sheerly due to limitations of screening.

In the second segment of an interview with HCPLive during the Maui Derm 2023 NP + PA Summer Conference in Colorado Springs this week, Dawn Eichenfield, MD, a dermatologist with Rady’s Children Hospital – San Diego, discussed the challenges of identifying pediatric allergic contact dermatitis. The first issue she and colleagues face, simply put, is that it’s harder to test a child with a smaller surface area.

"When you do a whole patch test series, you need enough skin to put all the patch tests on,” Eichenfield explained. “When you have a small child, you’re very limited in how many tests you could put on the kid. A lot of the tests aren’t modulated to children as well.”

Eichenfield noted that available patch test series are just different enough from one another that it leaves room for speculation especially in pediatric patients: did they provide a true negative, or is the test not as well calibrated to children as it is to adults.

“I think that sometimes with children, we see a lot more (different presentation) than the way it presents in adults, so that’s something else to keep in mind,” Eichenfield added. “In children, we see a lot more nickel allergy. I think we see a lot more fragrance allergies in kids, especially in those with an atopic diathesis.”

At times, it’s difficult to differentiate a fragrance allergy from a severe case of atopic dermatitis in a child, because the flaring associated with both may actually be a combination of diseases. Children also generally respond well to atopic dermatitis intervention, so there’s little thought for dermatologists to follow up on the possibility of a contact dermatitis.

Regarding the dynamic between allergists and dermatologists, Eichenfield praised what she sees as a “great camaraderie” in the overlapping space—especially in how it plays out at Rady’s multidisciplinary atopic dermatitis clinic. It’s not uncommon for her and dermatologists to get an assist from their allergy peers in particularly difficult cases.

“A lot of them also see really bad cases of atopic dermatitis as well, so they are helping us to manage some of our kids,” Eichenfield said. “It really depends on what is available nearby to the institution.”