Contact dermatitis in a child from methlychloroisothiazolinone and methylisothiazolinone in moist wipes

Pediatric Allergic Contact Dermatitis

Allergic contact dermatitis (ACD) affects up to 20% of adults and children, although children are infrequently patch tested. Available data suggest that children and adults, with or without atopic dermatitis, have the same prevalence of ACD. Patch testing is the gold standard for evaluation of ACD. The Pediatric Baseline Series was recently published by expert consensus for use in pediatric patch testing, with additional allergens tested as guided by history. This article examines methods of patch testing and up-to-date data on pediatric ACD. The top allergens are reviewed, and avoidance strategies are discussed.

Isothiazolinones: sensitizers not to miss in children

Isothiazolinone is known to be a sensitizer and a frequent cause of contact dermatitis in adults. Cases of contact dermatitis have also recently been reported in children. Derivatives of isothiazolinone, such as methylisothiazolinone (MI) and methylchloroisothiazolinone (MCI), are commonly used in the care products of babies and children. This allergen should not be missed.

Six children with allergic contact dermatitis to methylisothiazolinone in wet wipes (baby wipes)

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.