Sports participation provides a unique context for allergic contact dermatitis (ACD) in children, according to Elika D. Javaheri, medical student at the Mayo Clinic Alix School of Medicine, Rochester, Minnesota, who presented the results of a review of sports equipment implicated in ACD at the annual meeting of the American Contact Dermatitis Society.

More than half of school-aged children in the US participate in some form of sports, many of which involve equipment for protection or participation, such as balls, sticks, gloves, helmets, face masks, swim goggles, and shin guards, Javaheri said in her presentation. Sports activities are also associated with the additional ACD risk factors of heat, sweat, and repeated trauma to the skin, coupled with children’s immature skin barrier and vulnerability to ACD generally, she explained.

“We conducted a review to better characterize these exposures and identify practical management strategies, with the goal of helping children safely continue participating in the activities they enjoy,” Javaheri told Medscape Medical News.

She and her colleagues reviewed 30 articles from 1980 to 2024 on sports-related ACD in children and teens aged 18 years or younger.

Shin guards were among the top sources of sports-related ACD, with formaldehyde, rubber accelerators, and fabric dyes identified as the most common potential culprit allergens. Acetophenone azine is a more recently identified allergen associated with shin guard-associated ACD, Javaheri said.

For example, in one of the study, young athletes with ACD who underwent patch testing were positive for at least one allergen in the textile series, rubber series, or corticosteroid series, and several patients tested positive to raw materials from their own personal equipment.

Swim goggles are another common sports-related cause of ACD because of the presence of rubber accelerators, rubber vulcanizing agents or antioxidants, phenol-formaldehyde resin, or silicone, Javaheri noted.

Other exposures reported in the literature included rubber-related allergens from basketballs and volleyballs, as well as soccer goalkeeper gloves. Components of athletic tape have also been reported to cause ACD, as have sunscreens and fragrances when used frequently, Javaheri said.

Management and Prevention

Some specific modifications and substitutions can help manage ACD and allow children to continue participating in sports, Javaheri said.

“I was surprised by how many sport-specific modifications have been reported,” Javaheri told Medscape Medical News. “For example, alternatives such as silicone gasket swim goggles for patients with rubber additive sensitivities, or shin guards with different interior materials for those with fabric sensitivities, can significantly reduce symptoms,” she said. “These equipment-specific substitutions are often only known to athletes or those familiar with the sport, highlighting a possible knowledge gap among clinicians,” she noted.

In clinical practice, management of ACD needs to be individualized based on the specific sport and equipment, Javaheri said. If possible, clinicians should focus on identifying the relevant allergen and recommending practical modifications, such as switching to alternative materials or making sport-specific adjustments, she said.

“It is also important to balance dermatologic recommendations with safety and feasibility,” she said. Increased awareness of allergens associated with sports equipment may assist dermatologists in conducting thorough histories and deducing causes of ACD, she noted.

Looking ahead, more research is needed to develop therapeutic modifications and strategies so children and teens with sports-related ACD continue to use appropriate equipment for sports participation and safety, she said.

Studies such as those included in the current review show that sports equipment is a common cause of irritant or ACD in children, said JiaDe (Jeff) Yu, MD, chair of the Department of Dermatology at Virginia Commonwealth University, Richmond, Virginia, who was not involved in the study.

Although some allergens, such as those listed in the current study, have been associated with rashes after sports equipment use, irritant contact dermatitis, caused by friction, sweat, and other factors, is more likely to cause such rashes, Yu told Medscape Medical News. 

However, “When possible, patch testing children to common allergens in sports equipment, as well as a piece of the sports equipment itself, may be helpful to identify the culprit,” said Yu. “There may be many unknown, unidentified allergens in sports equipment, and more work is needed to correctly identify and avoid potential culprit allergens,” he added. 

The study received no outside funding. The researchers had no financial conflicts to disclose. Yu reported having no relevant financial conflicts of interest.