Journal Scan / Research · July 31, 2022 Patch Testing With Cobalt in Children and Adolescents Contact Dermatitis

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• This retrospective analysis characterized the authors' experiences with patch testing with cobalt in children. Of the 1919 children who underwent patch testing, 127 (6.6%) were found to have a clinically relevant positivity to cobalt. The cases were predominantly in a scattered generalized distribution, on the trunk, and on the face. The most common sources of cobalt exposures were jewellery and clothing.

• Cobalt exposure should be considered in children with possible allergic contact dermatitis in a scattered generalized distribution, on the trunk, or on the face.

–  Joshua R. Ortego, MD

Written by

 

 

Christen Maria Mowad MD

Cobalt has been cited as one of the top three most common allergens to cause allergic contact dermatitis in children in North America. It is felt to be more common in children and adolescents than adults. This study by the North American Contact Dermatitis group sought to better identify trends in cobalt allergy in children, as well as their associated patient characteristics, sources, and body sites.  

This retrospective study found that 11.9% and 6.6% of children had a positive allergy or currently relevant patch test reaction to cobalt. The most common body site was scattered generalized (30%), followed by face (10.6%) and trunk (10.1%). When relevant positive reactions were identified, the most common primary sites were the trunk and ears. The most commonly identified sources of cobalt included jewellery, belts, and clothing, and this varied by body site. They also found that allergy peaked at ages 14–15 but was relatively stable throughout childhood. They found no association of cobalt reactions with sex, atopy, race, or employment.

When interpreting patch test reactions to cobalt, clinicians need to remember the poral reactions that have a speckled appearance without papules or erythema that are felt to be irritants. The poral reaction may be seen more often with higher patch test concentrations of cobalt chloride. When instructing patients with identified cobalt allergy, the spot test for detecting cobalt can be helpful. This test is similar to the nickel dimethylglyoxime test. The cobalt spot test uses disodium-1-nitroso-2naphthol-3,6-disulphonate and produces a yellow-orange color in the presence of cobalt.

Given that the most common distribution of cobalt allergy in children was identified as a scattered generalized dermatitis followed by the trunk and face, clinicians should consider patch testing in children with dermatitis in these areas and remember the common potential sources of cobalt being clothing, jewellery, and belts.

Abstract 

BACKGROUND

Allergic contact dermatitis (ACD) to cobalt is more common in children and adolescents than adults. However, detailed information on sites and sources of cobalt ACD is limited.

OBJECTIVES

To assess trends in positive and clinically relevant patch test reactions to cobalt in children and associated patient characteristics, common sources and body sites affected.

METHODS

A retrospective analysis of children (<18 years) patch tested to cobalt by the North American Contact Dermatitis Group between 2001 and 2018.

RESULTS

Of 1919 children patch tested, 228 (11.9%) and 127 (6.6%) had a positive/allergic or currently relevant patch test reaction to cobalt, respectively. The most common primary body sites affected were scattered generalized (30.0%), face, not otherwise specified (10.6%) and trunk (10.1%). Patients with allergic and currently relevant allergic patch test reactions were more likely to have a primary site of trunk (p = 0.0160 and p = 0.0008) and ears (p = 0.0005 and p < 0.0001). Affected body site(s) varied by cobalt source among patients with currently relevant reactions, especially for less common sources. The most commonly identified sources of cobalt included jewellery, belts and clothing.

CONCLUSIONS

Positive patch test reactions to cobalt were common in children. The most common body site was scattered generalized and the sources of cobalt varied by body site.

Contact Dermatitis

Patch testing with cobalt in children and adolescents: North American contact dermatitis group experience, 2001–2018

Contact Derm 2022 Jul 08;[EPub Ahead of Print], JI Silverberg, N Patel, EM Warshaw, HI Maibach, DV Belsito, JG DeKoven, KA Zug, JS Taylor, D Sasseville, VA DeLeo, MD Pratt, MJ Reeder, AR Atwater, JF Fowler, MC Houle 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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