Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a combination preservative used in personal care and household products and is a common cause of allergic contact dermatitis (ACD). Recently, MI alone, without MCI, has been increasingly used in consumer products in attempts to minimize allergic reactions. Wet wipes are extensively tested and traditionally believed to be innocuous. MI in wet wipes (“baby wipes”) has not been previously reported to cause ACD in children in the United States. Only 1 previous report of ACD in a child in Belgium has been recently reported. We report 6 children with chronic, perianal/buttock, and facial eczematous dermatitis, refractory to multiple topical and oral antibiotics and corticosteroids. All tested positive to MCI/MI on patch testing. None wore diapers. All patients had been using wet wipes containing MI (without MCI) to affected areas. Discontinuation of wipes resulted in rapid and complete resolution. This is the first report of pediatric ACD to MI in wet wipes in the United States, and the largest series to date. ACD to MI in wet wipes is frequently misdiagnosed as eczema, impetigo, or psoriasis. Wet wipes are increasingly marketed in personal care products for all ages, and MI exposure and sensitization will likely increase. Dermatitis of the perianal, buttock, facial, and hand areas with a history of wet wipe use should raise suspicion of ACD to MI and prompt appropriate patch testing. Rapid resolution occurs after the allergen exposure is eliminated. All isothiozolinones should be avoided in personal care and household products for these patients.
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February 2014
Case Report|
February 01 2014
Six Children With Allergic Contact Dermatitis to Methylisothiazolinone in Wet Wipes (Baby Wipes)
Mary Wu Chang, MD;
aDepartments of Dermatology and Pediatrics, and
Address correspondence to Mary Wu Chang, MD, Departments of Dermatology and Pediatrics, University of Connecticut School of Medicine, 65 Memorial Rd, Ste 450, West Hartford, CT 06107. E-mail: mary.chang@pedsderm.com
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Radhika Nakrani, BS
Radhika Nakrani, BS
bMedical Student, University of Connecticut School of Medicine, Farmington, Connecticut
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Address correspondence to Mary Wu Chang, MD, Departments of Dermatology and Pediatrics, University of Connecticut School of Medicine, 65 Memorial Rd, Ste 450, West Hartford, CT 06107. E-mail: mary.chang@pedsderm.com
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2014) 133 (2): e434–e438.
Article history
Accepted:
August 01 2013
Citation
Mary Wu Chang, Radhika Nakrani; Six Children With Allergic Contact Dermatitis to Methylisothiazolinone in Wet Wipes (Baby Wipes). Pediatrics February 2014; 133 (2): e434–e438. 10.1542/peds.2013-1453
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Comments
Methylisothiazolinone: Beyond Wet Wipes
To the Editor:
We read with interest the article by Chang et al. Six Children With allergic Contact Dermatitis to Methylisothiazolinone in Wet Wipes (Baby Wipes).1 The authors discuss the increased use of methylisothiazolinone (MI) in consumer products and report 6 cases of patch tested children with perianal or facial dermatitis caused by use of MI containing wet wipes. In this series, the patients had rapid and complete resolution of their dermatitis upon discontinuation of wet wipes; a situation that might not occur, if there are additional sources of allergen exposure.
A case in point, we evaluated a 6 year old girl with a chronic intermittent perianal and vulvar dermatitis since infancy. At the time the patient developed this dermatitis she had repeated exposures to MI containing wet wipes. After multiple failed treatments with topical anti-yeast agents, topical corticosteroids and topical calcineurin inhibitors, an allergic contact dermatitis (ACD) was suspected and the family was instructed to stop using the wet wipes. The patient's dermatitis improved; however, she continued to have intermittent flares. Patch testing demonstrated a 2+ reaction to methylchloroisothiazolinone/methylisothiazolinone (MCI/MI). During patch testing she developed a flare of her dermatitis. In post-test counseling MI was found in the patient's moisturizer, shampoo and body wash.
We commend Chang et al. for their use of patch testing to confirm the culprit allergen in these patients who had a suspected source causing their dermatitis. Wet wipes have been associated as a cause of pediatric ACD, to both formaldehyde releasing and non-formaldehyde releasing preservatives and fragrances; as a result, identifying the culprit allergen is paramount in instructing avoidance.2 Simply discontinuing the use of wet wipes is not always the solution.
Patch testing can serve as a valuable tool in the work up of patients with persistent, treatment resistant dermatitis. Table I describes 5 pediatric cases we evaluated in the last year for persistent dermatitis. All 5 had confirmed positive patch test (PPT) reactions to MCI/MI with definite clinical relevance to one or more of their personal care products. All patients were able to clear their dermatitis with allergen avoidance measures. MCI/MI allergy should be considered in a variety of clinical pictures and is not limited to only facial and perianal dermatitis.
Table I. Patient's with clinically relevant patch test reactions to MCI/MI.
*Patient 3 also had a generalized dermatitis
**Patient 5's initial dermatitis was caused by wet wipes, with subsequent ectopic flares due to use of moisturizer, shampoo and body wash containing MI
References
1. Chang MW, Nakrani R. Six children with allergic contact dermatitis to methylisothiazolinone in wet wipes (baby wipes). Pediatrics. 2014 Feb;133(2):e434-8.
2. Guin JD, Kincannon J, Church FL. Baby-wipe dermatitis: preservative-induced hand eczema in parents and persons using moist towelettes. Am J Contact Dermat. 2001 Dec;12(4):189-92.
Conflict of Interest:
None declared