Contact allergy and patch testing in children; plus TB testing in biologics users, and telehealth pay expands

Dermatologists often are the first to notice allergic contact dermatitis exposure patterns in the pediatric population. Vincent DeLeo, MD, talks with Dr. Margo Reeder, Dr. Amber Reck Atwater, and Jennifer M. Tran about patch test practices in children for the diagnosis of ACD. Because children have unique product and environmental exposures, panels should be customized based on the patient’s exposure history. “Not only is ACD prevalent in children but also that the allergen profile is unique when compared to adults,” advises Dr. Reeder.

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We bring you the latest in dermatology news and research:

1. Repeat LTBI testing best in patients taking biologics with new risk factors
   Just 1.2% of patients taking biologics with negative tuberculosis test results converted to positive results in annual tuberculosis screenings.
2. More states pushing plans to pay for telehealth care
   But fair payment remains a challenge for providers.

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Things you will learn in this episode:

• Two studies – the North American Contact Dermatitis Group and the Pediatric Contact Dermatitis Registry – have shown positive patch test reactions in children at rates of 57% and 48%, respectively.
• Improve patch testing your pediatric patients by learning about nuances such as their unique exposures and how to work with the smaller surface area of their skin.
• Take a thorough history by asking parents to “walk through a day in the life of their child” to uncover exposures from personal care products, topical medications, hobbies, and any individuals who interact with them. “It’s where you truly have to bring out your inner Sherlock Holmes to determine what and where potential allergens are,” Ms. Tran advises.
• Common allergens found in the pediatric population include nickel, cobalt, neomycin, balsam of Peru, lanolin, fragrance mix I, and propylene glycol.
• Reassure worried children about patch testing by providing education and using distraction techniques. “We have photos, including photos of kids undergoing patch testing that we can show before we apply the patches just to show them exactly what’s going to happen,” Dr. Reeder says. “Distraction is important too.”
• Currently, three pediatric patch test screening series are available: T.R.U.E. Test, North American Pediatric Patch Test Series, and Pediatric Baseline Patch Test Series. Consult the Table online for information on these forms of patch testing.
• Allergen exposure can occur from sports equipment, jewelry, braces, keys, zippers, school chairs, electronics, and toys. “Musical instruments have also been implicated in contact dermatitis in children,” Dr. Atwater adds, “and believe it or not, toilet seat dermatitis has also been reported.”
• Consider patch testing in atopic dermatitis when the patient’s dermatitis has changed, is significantly different, or involves new areas of the skin.

Guests: Margo Reeder, MD (department of dermatology, University of Wisconsin, Madison); Amber Reck Atwater, MD; (department of dermatology, Duke University, Durham, N.C.); Jennifer M. Tran (department of dermatology, University of Wisconsin, Madison)

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Show notes by Jason Orszt, Melissa Sears, Elizabeth Mechcatie

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