Patterns of Pediatric Chronic Hand Eczema: A Systematic Review with Focus on Causes and Management.

Abstract

Chronic hand eczema (CHE) is commonly seen in adults and often in the context of occupational exposures. Recently, there has been a growing number of cases reported among children. We conducted a systematic review using the PRISMA framework to identify cases of pediatric CHE. Search terms included "eczema," "dermatitis," "pompholyx," "dyshidrosis," "contact allergy," and "pulpitis." Case reports of patients aged <18 years old without an alternate/confounding diagnosis were included. 62 cases were included with a mean age of 10.9 years. In the patients with reported data, 61% (28/46) had a history of atopy and 38% (14/37) reported lesions were present for >1 year. The most common cause was allergic-contact dermatitis (71%) with the bilateral hands affected (87%). A total of 35 unique triggers were identified, with the top 5 being homemade slime (n = 28), store-bought slime (n = 8), outdoor plants (n = 4), UV-curing methacrylate nail polish (n = 4), and sporting gloves (n = 4). Patch testing was performed in 87% (54/62) of patients, of which 96% (52/54) tested positive to 1+ allergens. Positive reactions to methylchloroisothiazolinone and/or methylisothiazolinone (MCI/MI) were among the most common. In 53% (33/62) of patients, removal of the trigger resulted in resolution. Patterns of CHE triggers in pediatric patients differ from adults, and workup should include a detailed history of leisure-time and school activities. MCI/MI was the most common culprit, and trends involving children making slime has led to an increase in prolonged/repeated exposure. Awareness of potential causes ensures early identification, patch testing, prompt removal of trigger, and appropriate management.