**9. Conclusions**

ACD in infancy is more frequent than was initially suggested, although its true prevalence and incidence continue to be unknown. Age and sex influence its development, but the

eruption produced by poison ivy is characterized by redness, papules, vesicles and bullae plus linear streaking. Occasionally, urticaria and eruptions, resembling erythema multiforme, measles or scarlatina, occur from systemic absorption of the poison ivy antigen (Rietschel & Fowler Jr., 2008b). Exposure can be direct or indirect, such as transfers of the allergen via animals, tools, clothing, golf clubs, etc. (Goossens & Morren, 2006; Rietschel & Fowler Jr., 2008b), which is more difficult to diagnose (Epstein 1971). A few cases of phytophotodermatitis from *Toxicodendron* in children were also reported (Goossens &

The cornerstone of treatment of ACD is proper allergen avoidance. Once an allergen is identified, patients must be educated on potential exposures, cross-reacting chemicals, preventive measures, as well as offered suggestions for avoidance. This may be especially difficult in households with small children affected, as the products that are used by the

Emollients can be added after a bath in an effort to retain hydration and restore the barrier function of the skin. Barrier repair also decreases pruritus and reduces visible scaling and dryness. Physical barrier creams may be useful in cases in which the allergen exposure cannot be avoided. Patients should apply the creams before and during the exposure in an

Topical corticosteroids are the first-line treatment modality for mild cases of ACD but they are not without risk and can cause multiple cutaneous side effects with extensive and long term use (Militello et al., 2006; Goossens & Morren, 2006; Jacob & Castanedo-Tardan, 2007; Lee et al., 2009). When selecting a topical corticosteroid for treatment, it is important to choose one that the patient is not allergic to in terms of the active ingredient (the steroid component) and inactive ingredients in the vehicle (Lee et al., 2009). As with any topical steroid, the risk of atrophy, teleangiectasias, tachyphylaxis and systemic absorption should be kept in mind, especially in areas of increased sensitivity such as face, groin and flexural

Topical calcineurin inhibitors (TCIs) are another therapeutic option and should be considered when steroid-sparing agents are required. These agents can be used for certain areas, such as the face, axilla and groin, which are more susceptible to steroid-induced

In cases of widespread and severe reactions, Militello et al. (Militello et al., 2006) recommended at least 3 weeks of oral prednisone in combination with topical therapy. Shorter courses often lead to rebound flares of the dermatitis. Systemic corticosteroids are generally started at 1 mg/kg per day (Brasch, 2009). Oral H1-antihistamines are widely used as an adjuvant nonspecific treatment for pruritus in infants and children. They also cause drowsiness that may help with sleeping disturbances from pruritus (Militello et al., 2006;

ACD in infancy is more frequent than was initially suggested, although its true prevalence and incidence continue to be unknown. Age and sex influence its development, but the

patents and sibling may also need to be considered as sources for allergen exposures.

Morren, 2006).

**8. Treatment** 

effort to decrease absorption (Lee et al., 2009).

area (Militello et al., 2006).

atrophy (Lee et al., 2009).

Lee et al., 2009).

**9. Conclusions** 

principal factor associated with ACD is the pattern of exposure to the various allergens (Vozmediano & Hita, 2005). In the unselected population, the prevalence of CA is about 20% (Mortz & Andersen, 1999; Weston & Weston, 1984; Barros et al., 1991), while in the selected population, the prevalence of ACD is found to be variable, with a mean of 40% (Mortz & Andersen, 1999; Wöhrl et al., 2003; Heine et al., 2004; Lewis et al., 2004; Seidenari et al., 2005; Vozmediano & Hita, 2005; Militello et al., 2006; Goossens & Morren, 2006; Jacob et al., 2008). The susceptibility to contact sensitization increases with the age. The most important allergens observed in this population are metals, mercury, pharmaceutical products and cosmetics (Vozmediano & Hita, 2005; Militello et al., 2006; Goossens & Morren, 2006; Jacob et al., 2008). ACD in childhood may also affect decisions regarding future occupations in adulthood. Therefore, it is very important that any CA in a child is recognized and dealt with in time. The impact of CA must not be underestimated, both on a complex individual scale of quality of life and socio-economically, for example, due to job options (Uter et al., 2004). Patch testing is both well tolerated and diagnostically essential in the evaluation of pediatric patients with potential ACD. Once allergen is documented, treatment relies on symptomatic use of topical or oral corticosteroids and meticulous allergen avoidance (Militello et al., 2006). Good information on preventing the development of ACD in children is useful for the caregivers.
