Allergic contact cheilitis in children and improvement with patch testing.pdfVIP

CASE REPORT Allergic contact cheilitis in children and improvement with patch testing Alyx Rosen, MD, Shanna Shan Yi Ng, MD, Antonella Tosti, MD, and Lawrence Schachner, MD Miami, Florida Key words: allergic contact cheilitis; contactants; patch testing. INTRODUCTION Pediatric cheilitis can be a debilitating condition for the child and parents. Patch testing can help isolate allergens to avoid. Here we describe a 2-yearold boy with allergic contact cheilitis improving remarkably after prudent avoidance of contactants and food avoidance. CASE REPORT A 2-year-old boy was referred by the pediatrician for recurrent lip dermatitis present for 2 years. He previously saw 2 other dermatologists. One prescribed topical tacrolimus 0.03% ointment, hydrocortisone 2.5% ointment, and desonide ointment for atopic cheilitis with minimal improvement in symptoms. The second dermatologist diagnosed lip licker’s dermatitis, and the same treatment was maintained. In addition, leaky gut syndrome was ruled out, and the patient had no improvement with aloe vera supplements or a gluten-free diet for 6 months and returned to eating a normal diet. Occasionally, he experienced ?ares with certain foods, including brown rice, citrus foods, candies, and bread. He was using a hypoallergenic lip balm twice daily and ?uoride-free toothpaste when he presented to our clinic. Medical history was otherwise unremarkable, with no history of atopy; the only medications were a daily multivitamin (Rainbow Light, Santa Cruz, CA) and occasional probiotic, and there were no known drug allergies. His family history was notable for an older brother with asthma and father with eczema and psoriasis. Examination found pink ?ssured plaques with mild yellow crust involving the perioral skin including the upper and lower lips. The rest of the Abbreviations used: ACC: allergic contact cheilitis Bronopol: 2-Bromo-2-nitropropane-1,3-diol MI: methylisothiazolinone MCI: methylchloroisothiazolinone Fig 1. Allergic contact ch