Primary Care

Editor’s Note - August 2014

Readers of Consultant for Pediatricians tell me they most appreciate articles that describe a pediatric condition and offer practical guidance about the best diagnostic tests and therapies to care for the young patients affected by it.

This issue’s excellent article on allergic contact dermatitis (ACD) features most of these valued components. Elise M. Herro, MD, and Sharon E. Jacob, MD, describe this ubiquitous condition in children and run through a litany of chemicals, medications, and food and cosmetic ingredients that are among the most common culprits in pediatric ACD. In particular, they discuss the diagnostic utility of patch testing to identify the allergen responsible for a child’s reaction.

What you won’t find in the article, however, is a tidy package of practical, sure-fire, effective ways to prevent ACD in children. This might be possible in articles on other allergies: A young patient is allergic to tree nuts? Educate about the importance of avoiding tree nuts. Penicillin allergy? Consider tetracyclines, macrolides, or fluoroquinolones.

But what if a child is allergic to dimethyl fumarate, a biocide applied to shipped goods? Or PPD, a chemical used in black henna hair dye? Or the unidentified allergen behind car seat dermatitis? It’s nearly impossible to offer practical advice about avoiding pervasive, invisible substances whose presence is undetectable and undisclosed.

Minimizing kids’ exposure to these allergens is a challenge that may be best approached with a unified voice at the national level. Government policies and regulations are vital to decreasing sensitization rates to many pediatric ACD allergens, Drs. Herro and Jacob write. They testify to the progress that is possible when health care organizations wield their clout: After the American Academy of Dermatology endorsed a ban on PPD-laced black henna tattoos in 2008, at least 3 states introduced legislation calling for the same.

Staying current with medical knowledge is crucial to effective health care. Consultant for Pediatricians can help. Visit the Dermatologic Disorders Medical Resource Center at for practical clinical resources and links to our Dermclinic quiz archives, where you can test your diagnostic skills on a range of pediatric skin problems.

I welcome your input. Post a comment at our site, send a note to, or call me at (800) 237-7285, extension 396.

Michael Gerchufsky, ELS, CMPP

Managing Editor