Patch Testing in Toilet Seat Dermatitis: A Case Series of Six Patients with Paediatric Atopic Dermatitis

Background: Toilet seat dermatitis (TSD) is a localized form of dermatitis that commonly occurs in the buttocks and upper posterior aspect of the thigh in school-going children. Previously, it was mostly seen due to allergic contact dermatitis to wood, but recently, many other allergens in toilet seats along with the possibility of irritant contact dermatitis (ICD) to detergents were reported. Materials and Methods: Six cases diagnosed clinically as atopic dermatitis per Hanifin and Rajka criteria presented with posterior thigh dermatitis. Patch testing using the Indian Standard Series, toilet seat scrapings, and detergents was conducted. Results: Patch testing showed negative results at 48, 96, and 168 hours, including lesional site testing. Symptomatic management, including topical steroids and later tacrolimus, was administered, coupled with counselling on toilet seat cover use, with a follow-up after four weeks. Lesions showed resolution and reduced itching. Limitation: This study's limitation lies in its small sample size from a single geographic area. Conclusion: Lesion resolution through topical treatment and toilet seat avoidance, support a diagnosis of contact dermatitis; however, the role of atopy remains crucial, suggesting a complex interplay. Larger studies are needed for a comprehensive understanding of this dermatological condition.